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With the patient in lateral recumbency, an intrathoracic view is best gained by pulmonary exclusion or limited pneumothorax. Several portal placements have been suggested in this approach. We recommend placement of the working channels at a sufficient distance from the heart to ensure adequate working space. The scope is placed in the middle or ventral third of the 10th intercostal space, just cranial to the diaphragm. The 5-mm instrument ports can then be placed cranial to the scope in the dorsal and ventral thirds of the sixth to eighth intercostal spaces (Figure 4) depending on the patient’s conformation. Dissection and resection can be accomplished with these two portals. Should another instrument be necessary (e.g., to move the cranial lung lobe aside), it could be placed in the ventral third of the third intercostal space.
Theoretically, subphrenic pericardectomy is optimal
in cases of constrictive pericarditis and pericardial infection or neoplasia, while the pericardial window can be used in cases of neoplastic effusions, hemorrhage from neoplastic masses, inflammatory disease, and idiopathic effusions. The pericardial window procedure was evaluated in a more recent study. This procedure was associated with an acceptable complication
rate (approximately 25%), low mortality rate (7%),
rapid operative duration (<1 hour), and relatively short hospitalization time (1 day). In that study, of seven
dogs with idiopathic pulmonary effusion, three died of uninvestigated lethargy and two were euthanized 638 and 1165 days after surgery, respectively, because of dyspnea secondary to persistent pleural effusion. These findings and those obtained by Case et al. again raise the question of the value of a simple pericardial window with respect to the long-term prognosis. Our recommendation is to remove as much pericardium as possible while avoiding any risk of phrenic nerve transection.
In one pericardioscopic study of cadaver, subphrenic pericardectomy allowed for better viewing of most intrapericardial structures than did the creation of an apical pericardial window. Greater than 50% visibility of the right atrium, right auricle, and left auricle was possible. Subphrenic pericardectomy improved observation of the aortic root and pulmonary artery, which is important in cases of mesothelioma or chemodectoma. Although subphrenic pericardectomy may not be necessary in all dogs with pericardial effusion, it may improve diagnostic accuracy during pericardioscopy.
Atencia S, Doyle RS, Whitley NT. Thoracoscopic pericardial window for management of pericardial effusion in 15 dogs. Journal of Small Animal Practice 2013; 54: 564–569.
Case JB, Maxwell M, Aman A et al. Outcome evaluation of a thoracoscopic pericardial window procedure or subtotal pericardectomy via thoracotomy for the treatment of pericardial effusion in dogs. Journal of the American Veterinary Medical Association 2013; 242: 493–498.
Dupré G, Corlouer J-P, Bouvy B. Thoracoscopic pericardectomy performed without pulmonary exclusion in 9 dogs. Veterinary Surgery 2001; 30: 21–27.
Dupré G Thoracoscopic Pericardial Window and Subtotal Pericardectomy in Dogs
and Cats, in Small Animal Laparoscopy and Thoracoscopy, First Edition. Edited by Boel A. Fransson and Philipp D. Mayhew, 294-301, 2015 by John Wiley & Sons, Inc.
Dunning D, Monnet E, Orton EC et al. Analysis of prognostic indicators for dogs with pericardial effusion: 46 cases (1985-1996). Journal of the American Veterinary Medical Association 1998; 212: 1276–1280.
Ehrhart N, Ehrhart EJ, Willis J et al. Analysis of factors affecting survival in dogs with aortic body tumors. Veterinary Surgery 2002; 31: 44–48.
Haimel G, Liehmann L, Dupré G. Thoracoscopic en bloc thoracic duct sealing and partial pericardectomy for the treatment of chylothorax in two cats. Journal of Feline Medicine and Surgery 2012; 14: 928–931.
Jackson J, Richter KP, Launer DP. Thoracoscopic partial pericardiectomy in 13 dogs. Journal of Veterinary Internal Medicine 1999; 13: 529–533.
Mayhew PD, Culp WTN, Mayhew KN et al. Minimally invasive treatment of idiopathic chylothorax in dogs by thoracoscopic thoracic duct ligation and subphrenic pericardiectomy: 6 cases (2007-2010). Journal of the American Veterinary Medical Association 2012; 241: 904–909.
Ployart S, Libermann S, Doran I, et al. Thoracoscopic resection of right auricular masses in dogs: 9 cases (2003-2011). Journal of the American Veterinary Medical Association 2013; 242: 237–241.
Skinner OT, Case JB, Ellison GW et al. Pericardioscopic imaging findings in cadaveric dogs: comparison of an apical pericardial window and sub-phrenic pericardectomy. Veterinary Surgery 2013; 43: 45–51.
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