Totally endoscopic subxiphoid pericardioscopy: early steps with a new surgical tool.
BACKGROUND
Pericardial pathology still has challenging diagnostic and treating issues. To reduce surgical trauma and pain for the patient, the authors developed a totally endoscopic echo-guided approach for both diagnostic and operative pericardioscopy.


METHODS
Three steps moved from animal model (8 pigs) through concomitant open-chest interventions (7 patients) to closed-chest interventions for 10 patients with a diagnosis of severe pericardial effusion.


RESULTS
A lesion of the right ventricle in one patient (10%) due to imperfect preoperative pericardial visualization needed sternotomy for repair. All the patients, except the aforementioned one, underwent surgery with local anesthesia or mild sedation. No method-related mortality was reported.


CONCLUSIONS
The closed-chest nonintrapleural approach to the pericardium may represent an evolution, with a positive impact on the treatment of this pathology. Therapeutic maneuvers with rigid instruments in nonintubated patients are possible. Accurate patient selection and technical refinement should increase the safety and effectiveness of the method.
Manca
Giuseppe
G
Division of General Surgery, Careggi University Hospital, Viale Pieraccini 17, 50139, Florence, Italy.
Codecasa
Riccardo
R
Valeri
Andrea
A
Braconi
Lucio
L
Giunti
Gabriele
G
Tedone
Alessandro
A
Perna
Avio Maria
AM
Stefàno
Pierluigi
P
Gensini
Gianfranco
G
D000818:Animals; D004452:Echocardiography; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D023421:Models, Animal; D010490:Pericardial Effusion / Q000000981:diagnostic imaging* / Q000601:surgery*; D010491:Pericardial Window Techniques / Q000295:instrumentation*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D013552:Swine; D014989:Xiphoid Bone