Completely thoracoscopic bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation

摘要

e describe a minimally invasive surgical technique involving completely thoracos.copic bilateral pulmonary vein isolation and left" atrial appendage exclusion for the treatment of atrial fibrillation.ln January and February 2007, we performed nine totally thoracoscopic bilateral pulmonary vein isolations and left atrial appendage exclusions. All patients (mean age 59.7 +- 8.8 years) had paroxysmal atrial fibrillation. Four patients had a history of repeated unsuccessful percutaneous catheter procedures. Magnetic resonance imaging of the pulmonary veins showed a left common trunk pulmonary vein in one patient whereas normal anatomy was observed in the other patients.All patients were operated on under general anesthesia in the su-. pine position with both arms slightly flexed along the body. A slight tilt of the operating table without repositioning of the patient was sufficient for adequate exposure on both sides. Furthermore, in case of an urgent sternotomy, repositioning of the patient was not necessary. Three thoracoports were introduced on each side, the first on the midaxillary line and a second 5 cm anteriorly through the fourth intercostal space. The third port was inserted caudally of the first port through the sixth intercostal space (Figure 1).