Perikardiektomia torakoskopowa. Wskazania i techniki u małych zwierząt. Część II/Thoracoscopic pericardectomy. Indications and techniques in small animals. Part II

Complications encountered during thoracoscopic pericardectomy

Technical problems

Grasping the pericardium is sometimes difficult because it has a tendency to slip away from the instrument. Alternatively, a regular grasping forceps or an Allis tissue forceps can be used. Some surgeons pass a half-circle needle through the pericardium to create traction and facilitate the first puncture.

Blind puncture of the pericardium with a scalpel blade should be avoided. Inadequate visualization may occur in both positions (with or without one-lung ventilation) when the pericardial sac occupies most of the thoracic cavity. In such cases, time must be taken to push the lungs aside. Early drainage of the pericardium allows for better visualization and more rapid return of cardiac performance.

Breed has a significant influence on working space during thoracoscopy with deep-chested breeds exhibiting much greater working space compared to flat-chested (often brachycephalic) dog. When the instruments cannot move as freely as expected within the thoracic cavity, the cannulae can be removed so that the instruments obtain a greater degree of freedom. Alternatively, flexible cannulas can be used.

Pre-operative complications

Although distension of the pericardium is helpful during surgery, it is recommended to empty partially the pericardial sac before anesthesia to prevent cardiac tamponade (40). For the same reason moving and rolling the patient during surgical preparation shall be restricted.

Per-operative complications

Most cases of bleeding can be controlled but conversion might be indicated. It was leant necessary in one study after bleeding from the ventral mediastinum happened (39). In our experience, hemorrhages happened on two occasions, once because of an inadvertent myocardial puncture in a dog; that did not necessitate any conversion. Another one happened due to an auricular puncture in one cat presented for chylothorax and chylopericardium and ...

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