Name of the Procedure:

Thoracoscopy, diagnostic (separate procedure); pericardial sac, with biopsy
Common Name: Thoracic Endoscopy with Pericardial Biopsy

Summary

A thoracoscopy with pericardial biopsy is a minimally invasive surgical procedure in which a doctor uses a small camera (thoracoscope) and instruments to examine the pericardium (the sac around the heart) and take tissue samples (biopsy) for further analysis.

Purpose

This procedure is performed to diagnose or evaluate diseases affecting the pericardial sac, such as infections, cancer, or inflammatory conditions. The goal is to obtain tissue samples for examination under a microscope, leading to accurate diagnosis and appropriate treatment planning.

Indications

• Unexplained pericarditis (inflammation of the pericardium)
• Pericardial effusion (abnormal fluid accumulation)
• Suspected pericardial tumors or masses
• Persistent or recurrent chest pain
• Diagnostic clarification when non-invasive tests are inconclusive

Preparation

• Patients are usually instructed to fast for 6-8 hours before the procedure.
• Blood tests, electrocardiograms (EKG), and imaging studies like chest X-rays or echocardiograms may be required.
• Patients need to inform their doctor about all medications they are taking, especially blood thinners, which may need to be adjusted.

Procedure Description

1. The patient is given general anesthesia to ensure they are asleep and pain-free.
2. The surgeon makes small incisions between the ribs on one side of the chest.
3. A thoracoscope (a thin, flexible tube with a camera) is inserted through one of the incisions to visualize the pericardial sac.
4. Specialized instruments are introduced through other small incisions to take biopsies from the pericardium.
5. The collected tissue samples are sent to a lab for histological examination.
6. Once the procedure is completed, the instruments are removed, and the incisions are closed with sutures or staples.

Duration

The procedure typically takes between 1 to 2 hours.

Setting

This procedure is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Cardiothoracic surgeon
• Surgical nurses
• Anesthesiologist
• Histology technicians (for biopsy analysis)

Risks and Complications

• Infection at the incision sites
• Bleeding or hematoma formation
• Damage to surrounding organs or structures
• Pneumothorax (collapsed lung)
• Adverse reactions to anesthesia
• Rarely, heart injury

Benefits

The primary benefit is acquiring detailed diagnostic information that non-invasive methods cannot provide. Accurate diagnosis leads to more precise treatment plans and better management of the underlying condition. Some patients notice improvement in symptoms, especially if effusion or inflammation is drained or addressed.

Recovery

• Patients may stay in the hospital for 1-2 days for observation.
• Pain at the incision sites is common and can be managed with pain medication.
• Instructions will include wound care, activity restrictions (like avoiding strenuous activities), and follow-up visits.
• Full recovery usually occurs within 1-2 weeks, depending on the individual’s overall health and the complexity of the biopsy.

Alternatives

• Non-invasive imaging tests (e.g., MRI, CT scan, echocardiogram)
• Pericardiocentesis (draining fluid without tissue sampling)
• Open surgical biopsy, which is more invasive but may be necessary in specific cases
• Pros and Cons: Non-invasive tests are less risky but may not provide as definitive a diagnosis, while open surgery can offer comprehensive results but comes with higher risks and longer recovery times.

Patient Experience

During the procedure, the patient will be under general anesthesia and unaware of the surgery. Afterward, some pain or discomfort at the incision sites is expected, which can be managed with prescribed pain relief. Most patients can return to normal activities within a few weeks, adhering to any restrictions provided by their healthcare provider.