Epicardial exposure provided by a novel thoracoscopic pericardectomy technique compared to standard pericardial window

Objective(1) To describe a novel technique for thoracoscopic pericardectomy using a pericardial window with vertical pericardial fillets (PW+F). (2) To compare epicardial exposure between a standard pericardial window (PW) and PW+F. Study designExperimental study. AnimalsPurpose-bred research dogs (n=12). MethodsPW was performed through a 3-port subxiphoid thoracoscopic approach. After PW, vertical fillets were made in the pericardium for PW+F. Thoracoscopic images from 3 views were acquired after each procedure, and percentage of epicardial surface exposed (PESE) was compared. Epicardial exposure and iatrogenic damage to surrounding structures were directly assessed via postmortem gross examination. ResultsThe exposed epicardial surface (PESE) was increased with our novel compared to the standard technique. Median surgery time for PW+F was 25 minutes. The procedure was performed in 11 of 12 dogs without iatrogenic damage to surrounding structures. In 1 dog, the electrosurgery device contacted the epicardium and caused fatal ventricular fibrillation while performing PW+F. Based on postmortem assessment in all dogs with PW+F, the pericardium could move freely away from the heart, exposing the majority of the epicardial surface. ConclusionThoracoscopic PW+F is a novel technique that improves the exposure of the epicardium compared to standard PW. While PW+F can be performed successfully and in an efficient manner, the surgeon must be aware of the risk of iatrogenic trauma to thoracic structures when using electrosurgery. Clinical relevancePW+F offers a relatively safe, efficient, and effective minimally invasive method that improves the exposure of the epicardium compared to PW.