Name of the Procedure:

Thoracoscopy, surgical; with creation of pericardial window or partial resection of pericardial sac for drainage

Summary

A thoracoscopy with creation of a pericardial window involves using a thoracoscope to visualize the chest cavity and surgically creating an opening in the pericardial sac to drain excess fluid. This procedure helps alleviate pressure around the heart caused by fluid buildup.

Purpose

This procedure addresses issues related to pericardial effusion, which is the accumulation of fluid around the heart. The goals are to relieve pressure on the heart, improve cardiac function, and prevent further fluid accumulation.

Indications

• Persistent or recurrent pericardial effusion
• Symptoms of cardiac tamponade: chest pain, breathing difficulties, and low blood pressure
• Diagnostic evaluation of the pericardial sac and surrounding tissues

Preparation

• Fasting for at least 6-8 hours before the procedure
• Adjustment of current medications as instructed by the healthcare provider
• Pre-operative diagnostics like blood tests, electrocardiogram (ECG), and imaging studies such as an echocardiogram or chest X-ray

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
2. Thoracoscope Insertion: A small incision is made in the chest, and a thoracoscope (a thin, flexible tube with a camera) is inserted.
3. Visualization: The thoracoscope allows the surgeon to visualize the chest cavity and locate the pericardial sac.
4. Creation of Pericardial Window: The surgeon creates an opening in the pericardial sac to allow the fluid to drain into the chest cavity, from where it can be absorbed or drained externally.
5. Closure: The incision is closed with sutures, and a drainage tube may be placed to prevent fluid accumulation post-operatively.

Duration

The procedure typically takes 1-2 hours.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Cardiothoracic Surgeon
• Anesthesiologist
• Surgical Nurses
• Operating Room Technicians

Risks and Complications

• Infection
• Bleeding
• Injury to surrounding organs or structures
• Anesthesia-related risks
• Recurrence of effusion
• Cardiac complications such as arrhythmias

Benefits

• Relief from symptoms of pericardial effusion
• Improved heart function
• Prevention of recurrence of fluid accumulation
• Better diagnostic understanding of underlying conditions

Recovery

• Hospital stay of 1-3 days for monitoring
• Post-procedure care includes pain management, wound care, and monitoring for complications
• Gradual return to normal activities within 2-4 weeks
• Follow-up appointments to assess recovery and ensure no recurrence of effusion

Alternatives

• Pericardiocentesis (needle drainage of pericardial fluid)
• Medical management with anti-inflammatory medications
• More invasive surgical procedures like pericardiectomy (complete removal of the pericardium)

Patient Experience

• During the procedure: The patient will be under general anesthesia and will not feel any pain.
• After the procedure: Patients may experience discomfort at the incision site, manageable with prescribed pain medications. Full recovery can take several weeks, with gradual improvement in symptoms and return to daily activities.