Minimally Invasive Surgery for Pericardial Effusion and Tamponade

1
Minimally Invasive Surgery for Pericardial
Effusion and Tamponade

• Partial pericardiectomy
• Hemostasis
• Chest tube drainage

Pericardial window
2
Thoracoscopic Pericardiectomy for Malignant
EffusionSurvival in Months
3
Thoracoscopic PericardiectomySurvival in Months
N22
4
Malignant Pericardial EffusionComparative
Survival
5
Malignant Pericardial Effusion Comparative
Survival Breast CA
6
Malignant Pericardial Effusion Comparative
Survival Lung CA (NSC)
7
Conclusion

• Thoracoscopic pericardiectomy is a
• Simple
• Safe
• Effective
• technique for the management of malignant
  pericardial effusion and tamponade

8
Pleural Effusion
Inverts the diaphragm, so thoracic cavity gets
smaller with inspiration L2 dyspnea

• Very common clinical problem.
• Starling forces
• DDx by Light criteria
• Sp. Gr., protein, glucose, LDH, cultures
• Pleural Bx gt thoracoscopy
• DOE caused by paradoxical diaphragm
• Rx depends upon Dx

Always do a pleurocentesis
9
Malignant Pleural Effusion
Almost never a transudate
Any CA can cause this, but most common w/

• Very common clinical problem in tumors that
  involve thoracic nodes
• LunggtBreastgtLymphoma.
• Short survival
• Adverse QOL
• Effective palliative Rx is currently by
  pleurodesis.

Stick parietal w/ visceral pleura
10
Thoracoscopy
Tumor nodule

• Minimally invasive technology
• Better visualization of intrathoracic structures
• Limited palpation
• Technical Limitations

• Technology is in evolution
• Diagnostic
• Therapeutic
• benign nodules and mediastinal tumors
• metastases
• lung CA? Nope

11
Pleurodesis

• Instill a substance into the pleura that causes
  inflammation and symphysis of the visceral and
  parietal pleura.
• No residual space is left for recurrence of
  effusion.

• Chest tube alone lt40
• Tetra-Doxycycline
• lt 60
• Bleomycin better than Doxy but .
• Talc lt70-90
• slurry
• powder via thoracoscope

Cheap like mud
12
PleurX Catheter
For pleurodesis
Other Tx can be given thru this catheter

• New technique
• Outpatient placement of silastic cuffed catheter.
• Outpatient drainage of recurrent pleural effusion
  for palliation.

catheter
13
Chylothorax

• Leakage of chyle from a defect in the thoracic
  duct.
• High fat, protein loss.
• Death by starvation.
• Etiology
• congenital
• trauma
• tumor
• Rx thoracic duct ligation

Usu. milky white liquid
Tx