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

Thoracoscopic pericardectomy. Indications and techniques in small animals. Part II

Frequently asked questions

How to get working space into the chest?

Whatever recumbency is chosen, the working space into the thorax is established by causing an open-pneumothorax, by using open cannulas. Because of the atmospheric pressure into the chest, the lungs will fall away due to the gravity. This technique is usually sufficient with the patient in dorsal recumbency. With the patient in other positions some retraction of the lung lobes is usually necessary in order to gain access to the pericardium. Alternatively with the patient in lateral recumbency one-lung ventilation can be used (OLV) (19, 26).

Although a significant ventilation-to-perfusion mismatch occurs during OLV, studies have shown no large effect on oxygen delivery in healthy dogs (36). Finally, into the chest, CO2 may also be insufflated moderately to improve significantly the field of view in lateral recumbency (37).

However, insufflation even at low pressures (3 mmHg) (38) carries the risk of compressing intra-thoracic structures (vessels, airways) and of cardio-pulmonary depression; it shall be used with caution but is particularly valuable in small dogs and cats where some working space shall be gained.

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