32661 Thoracoscopy, surgical; with excision of pericardial cyst, tumor, or mass

Name of the Procedure:

Thoracoscopy, Surgical; with Excision of Pericardial Cyst, Tumor, or Mass
Also known as: Video-assisted Thoracoscopic Surgery (VATS) for Pericardial Mass

Summary

In this minimally invasive procedure, a surgeon uses a special instrument called a thoracoscope to view the chest cavity and excise (remove) a cyst, tumor, or mass from the pericardium, which is the sac surrounding the heart.

Purpose

This procedure is performed to remove abnormal growths in the pericardium, which can cause symptoms and potentially complications if left untreated. The goals include diagnosing and eliminating pericardial masses, alleviating symptoms, preventing complications, and improving overall cardiac function.

Indications

• Presence of a pericardial cyst, tumor, or mass detected via imaging studies.
• Symptoms such as chest pain, shortness of breath, or arrhythmias caused by the pericardial mass.
• Need for histopathological diagnosis of the pericardial mass.
• Failure of less invasive treatments and observation to manage the mass or cyst.

Preparation

• Patients may be instructed to fast (not eat or drink) for a certain period before the procedure.
• Medication adjustments, including stopping blood thinners, may be necessary.
• Pre-procedure diagnostic tests may include blood work, ECG, echocardiogram, and imaging studies like CT or MRI scans.
• Patients should discuss their medical history and current medications with their healthcare provider.

Procedure Description

1. Anesthesia: The procedure is performed under general anesthesia.
2. Incisions: Small incisions are made in the chest.
3. Thoracoscope Insertion: A thoracoscope (a thin, flexible tube with a camera) is inserted through one of the incisions to provide a visual of the chest cavity.
4. Instrument Insertion: Specialized surgical instruments are inserted through other incisions.
5. Excision: The surgeon carefully excises the pericardial cyst, tumor, or mass.
6. Closure: Once the mass is removed, the instruments and thoracoscope are withdrawn, and the incisions are closed with sutures or staples.

Duration

The procedure typically lasts between 2 to 3 hours.

Setting

It is performed in a hospital, generally in an operating room equipped for thoracic surgeries.

Personnel

• Surgeon: A thoracic or cardiothoracic surgeon performs the procedure.
• Anesthesiologist: Manages anesthesia and monitors the patient’s vital signs.
• Surgical nurses and technicians: Assist with the surgical procedure.

Risks and Complications

• Common Risks: Infection, bleeding, pain at incision sites.
• Rare Risks: Injury to nearby organs (lungs, heart), anesthesia complications, blood clots, prolonged air leak from the lung.
• Management: Most complications are managed with medications, additional procedures, or supportive care.

Benefits

• Immediate Benefits: Relief from symptoms caused by the pericardial mass, such as chest pain and shortness of breath.
• Long-term Benefits: Reduced risk of complications related to untreated pericardial masses, improved cardiac function.

Recovery

• Patients usually stay in the hospital for a few days post-procedure.
• Instructions may include wound care, activity restrictions, and pain management.
• Full recovery may take several weeks, with follow-up appointments to monitor healing and ensure the efficacy of the surgery.
• Gradual return to normal activities as advised by the healthcare provider.

Alternatives

• Observation: Monitoring the mass via regular imaging if asymptomatic and small.
• Open Surgery: More invasive but may be necessary for larger masses.
• Percutaneous Drainage: Possible for cysts but not tumors.
• Pros and Cons: Minimally invasive surgery typically offers faster recovery and fewer complications compared to open surgery but may not be suitable for all cases.

Patient Experience

• During the procedure, patients will be under general anesthesia and feel no pain.
• Post-procedure, patients may experience discomfort, mild pain at incision sites, and tiredness.
• Pain is managed with medications, and full activity typically returns gradually over several weeks. Comfort measures include pain relief medications and proper wound care.