32658 Thoracoscopy, surgical; with removal of clot or foreign body from pericardial sac

Name of the Procedure

Thoracoscopy, surgical; with removal of clot or foreign body from pericardial sac

• Common Names: Thoracoscopic Pericardial Clot/Foreign Body Removal, VATS Pericardial Debridement
• Medical Terms: Video-Assisted Thoracoscopic Surgery (VATS) for Pericardial Evacuation

Summary

Thoracoscopy with removal of a clot or foreign body from the pericardial sac is a minimally invasive surgical procedure. This procedure uses a tiny camera and specialized instruments to remove clots or foreign objects from the sac surrounding the heart (the pericardium).

Purpose

This procedure addresses issues such as the presence of blood clots or foreign bodies in the pericardial sac that can impair heart function.

• Goal: To safely remove the obstructive material, relieving symptoms and preventing complications like cardiac tamponade.

Indications

• Symptoms: Chest pain, shortness of breath, palpitations, or signs of cardiac tamponade.
• Conditions: Trauma, post-surgical complications, pericardial effusion diagnosed via imaging.
• Patient Criteria: Suitable for patients with confirmed clot or foreign body within the pericardium.

Preparation

• Pre-procedure Instructions: Fasting for at least 8 hours, stopping certain medications as directed by the physician.
• Required Diagnostics: ECG, chest X-ray, echocardiogram, blood tests to evaluate general health and clotting function.

Procedure Description

1. The patient is given general anesthesia.
2. Small incisions are made in the chest to insert the thoracoscope and specialized surgical instruments.
3. The thoracoscope (a tiny camera) provides a visual of the pericardial space.
4. The surgeon uses instruments to carefully remove the clot or foreign body.
5. Once the material is removed, the area is inspected to ensure no residual matter remains.
6. Instruments are withdrawn, and incisions are sutured closed.

Duration

Typically, the procedure takes 1 to 2 hours.

Setting

This surgery is performed in a hospital's operating room or a specialized surgical center.

Personnel

• Thoracic or Cardiovascular Surgeon
• Surgical Nurses
• Anesthesiologist
• Surgical Technicians

Risks and Complications

• Common Risks: Infection, bleeding, pain at incision sites.
• Rare Complications: Injury to surrounding organs, arrhythmias, adverse reaction to anesthesia.

Benefits

• Expected Benefits: Relief from symptoms, prevention of cardiac tamponade, and improved heart function.
• Timeframe: Benefits are typically realized immediately post-surgery, with full recovery in weeks.

Recovery

• Post-procedure Care: Pain management, activity restrictions, wound care instructions.
• Expected Recovery Time: Typically 1 to 2 weeks for initial recovery, full return to normal activities in 4 to 6 weeks.
• Follow-up: Regular follow-up appointments to monitor healing and cardiac function.

Alternatives

• Non-surgical Options: Medication for symptom management, pericardiocentesis (drainage of fluid without direct clot removal).
• Comparison: Non-surgical options may be less invasive but might not be as effective in removing solid clots or foreign bodies directly.

Patient Experience

• During Procedure: Under general anesthesia, the patient will be asleep and pain-free.
• After Procedure: Mild to moderate pain managed with medication, some discomfort at incision sites, and limited physical activity for a short period.
• Pain Management: Pain relief medications, ensuring patient comfort during recovery.