VIDEOSURGERY OF PERICARDIAL-EFFUSION - TE CHNIQUE AND RESULTS

Videosurgery is a relatively non-invasive method of draining the peric ardium by the creation of a pleuropericardial window. It provides an e xcellent view of the thoracic cavity and allows selection of pericardi al and pleural, pulmonary or mediastinal biopsy sites. The authors rep ort their preliminary results with this technique. Between May 1994 an d May 1995, 22 patients with pericardial effusions were operated by vi deosurgery at the Pitie Hospital. None of the patients had clinical si gns of tamponade. The technique consists in introducing, through 2 or 3 thoracic incisions of 15 mm, trocarts allowing passage of an endosco pic camera and different surgical instruments Access to the thoracic c avity enabled assessment of the pleura, evacuation of pleural effusion s (n = 8) and biopsy of pleural nodules (n = 2). One pulmonary biopsy was performed. Opening the pericardium enabled evacuation of pericardi al effusions averaging 622 ml. Pericardial biopsies showed appearances suggesting tuberculosis (n = 2), lupic vasculitis (n = 1) and post-ra diation pericarditis (n = 1). In other cases, a histologic diagnosis o f non-specific pericarditis was made. A biopsy of a pleural nodule sho wed undifferentiated carcinoma in one case. A pulmonary biopsy reveale d the presence of relatively undifferentiated carcinoma. There were no complications related to the technique. There was one recurrence of p ericardial effusion at one month in a patient with carcinoma of the lu ng who had previously had subxiphoid drainage. There were no cases of secondary pericardial constriction. Therefore, videosurgery is a relat ively non-invasive and effective technique of pericardial drainage and biopsy. When there is no emergency, it is probably the method of choi ce in the treatment and diagnosis of pericardial effusions.