METHOD FOR VIDEOTHORACOSCOPIC FENESTRATION OF PERICARDIUM FOR TREATING PATIENTS WITH EXUDATIVE PERICARDITIS AND RISK OF HEART TAMPONADE

摘要

The method for videothoracoscopic fenestration of pericardium for treating the patients with the exudative pericarditis and the risk of tamponade of the heart is disclosed. The patient lies on the surgical table on the right side at the angle of 45 DEGREE . The surgeon stays on the left side. Upon the weak carboxitorax, three trocars are inserted into the pleural cavity at the left and the topography of pericardodiaphragmatic vascular and nervous bundle is assessed. The openings in the pericardium are generated, 5-7 cm in diameter in front of pericardodiaphragmatic vascular and nervous bundle near the apex of the heart. The content from the pericardial cavity is withdrawn, the pleural cavity is drained according to Bulau's technique. The first trocar (optic port 5 mm) is inserted in the anterior axillary line at the site of small incision, 1.0-1.5 cm in the sixth intercostal space. The endoscopic tools (scissors or hook-shaped diathermocoagulator is inserted through the trocar (5 mm) in the seventh intercostal space between the anterior axillary line and the midclavicular line. The additional opening, 2-3 cm in diameter, is generated in pericardium behind pericardodiaphragmatic vascular and nervous bundle opposite to the first opening. The preliminary needle puncture is not performed.