title: Thoracoscopic subphrenic pericardectomy using double-lumen endobronchial intubation for alternating one-lung ventilation.
abstract: OBJECTIVE
  To report the technique, complications, and effectiveness of thoracoscopic subphrenic pericardectomy (SPP) using double-lumen endobronchial intubation for alternating 1-lung (OLV) in healthy dogs.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Mature purpose-bred dogs (n=7).
  
  
  METHODS
  Bronchoscope-assisted placement of a left-sided double-lumen endobronchial tube, immediately before surgery, allowed intraoperative alternation of ventilation between lung fields. A camera portal was established in a subxyphoid location. Two instrument portals were established at the 4th-6th intercostal spaces on the right and left sides. A vessel-sealing device was used to create the subphrenic pericardectomy. After termination of the procedure, dogs were humanely euthanatized under anesthesia and necropsy performed. In each dog, the extent of pericardectomy and any complications were evaluated.
  
  
  RESULTS
  Technical difficulties with tube placement occurred in 4 dogs, but alternating OLV was achieved in all dogs and SPP completed successfully. Median surgical time was 87.5 minutes (range, 80-105 minutes). At necropsy, 0.5-2 cm of pericardial tissue remained ventral to the intact phrenic nerve in 6 dogs; in 1 dog, the phrenic nerve was transected on the left side only.
  
  
  CONCLUSIONS
  Thoracoscopic subphrenic pericardectomy is a technically feasible procedure in healthy dogs. Double-lumen endobronchial intubation allowed alternating OLV without intraoperative bronchoscopically guided tube manipulation in all but 1 dog.
  
  
  CONCLUSIONS
  Thoracoscopic subphrenic pericardectomy could potentially be used for management of conditions where relief of pericardial constriction or access to intrapericardial structures is desired.
authors.affiliation: Department of Clinical Studies, Matthew J. Ryan Veterinary Hospital, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Kelli N
authors.initials: KN
authors.lastname: Mayhew
authors.forename: Philipp D
authors.initials: PD
authors.lastname: Mayhew
authors.forename: Laurie
authors.initials: L
authors.lastname: Sorrell-Raschi
authors.forename: Dorothy Cimino
authors.initials: DC
authors.lastname: Brown
mesh_terms: D000769:Anesthesia, Inhalation / Q000662:veterinary; D000818:Animals; D004285:Dogs / Q000601:surgery*; D005260:Female; D007442:Intubation, Intratracheal / Q000662:veterinary*; D008297:Male; D010492:Pericardiectomy / Q000379:methods / Q000662:veterinary*; D011446:Prospective Studies; D001261:Pulmonary Atelectasis / Q000662:veterinary; D012121:Respiration, Artificial / Q000662:veterinary*; D013906:Thoracoscopy / Q000379:methods / Q000662:veterinary*