Thoracoscopic Subphrenic Pericardectomy Using Double-Lumen Endobronchial Intubation for Alternating One-Lung Ventilation
Article first published online: 8 DEC 2009
© Copyright 2009 by The American College of Veterinary Surgeons
Volume 38, Issue 8, pages 961–966, December 2009
How to Cite
MAYHEW, K. N., MAYHEW, P. D., SORRELL-RASCHI, L. and CIMINO BROWN, D. (2009), Thoracoscopic Subphrenic Pericardectomy Using Double-Lumen Endobronchial Intubation for Alternating One-Lung Ventilation. Veterinary Surgery, 38: 961–966. doi: 10.1111/j.1532-950X.2009.00583.x
- Issue published online: 8 DEC 2009
- Article first published online: 8 DEC 2009
- Submitted August 2008; Accepted March 2009
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.
Study Design— Prospective cohort study.
Animals— 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.
Clinical Relevance— Thoracoscopic subphrenic pericardectomy could potentially be used for management of conditions where relief of pericardial constriction or access to intrapericardial structures is desired.