Safety and feasibility of thoracoscopic pericardial window in recurrent pericardial effusion - A single-centre experience

Background:This study aimed to report the surgical outcomes and also evaluating the safety and feasibility of thoracoscopic pericardial window (PW) for recurrent pericardial effusion.This was a retrospective analysis of eight cases of recurrent pericardial effusion, managed by thoracoscopic method in a tertiary-level thoracic surgery centre over 5 years. A detailed analysis of all perioperative variables, including complications, was carried out.A total of eight patients underwent thoracoscopic PW during the study period. Males (87.5%) were predominant in the cohort. The median age was 54 years (range: 28-78 years). The median duration of symptoms was 2 months (range: 1-3 months). Tuberculosis (50%), malignancy (37.5%) and chronic kidney disease (12.5%) were the causes of recurrent effusion. All patients underwent thoracoscopic procedure with no conversions. The median operative time was 45 min (range: 40-70 min). The median effusion volume drained was 500 +/- 100 ml. The median hospital stay was 3 days (range: 2-4 days) with no post-procedural complications. All the patients had complete resolution of symptoms. No recurrence was noted in the median follow-up period of 28 months (range: 6-60 months).Thoracoscopic PW is a safe and feasible minimally invasive option in the management of recurrent pericardial effusion in selected patients. Surgical fitness, haemodynamic status and estimated survival (in malignant effusion) should be considered before the procedure.Recurrent pericardial effusion can be secondary to malignancy, tuberculosis, end-stage renal disease and collagen vascular diseases.[1,2] The severity can range from mild, asymptomatic effusion to massive effusion causing cardiac tamponade. For symptomatic pericardial effusion, either therapeutic needle pericardiocentesis or pericardial catheter drainage is indicated. However, in cases of 'failure' or 'non-feasibility' of these methods (due to the presence of multiloculations or posterior pericardial collections), 'pericardial window' (PW) is the definitive treatment option.PW is created by the removal of a part of the pericardium (partial pericardiectomy) to form a communication between the pericardium and the pleural cavity. This can be achieved through a subxiphoid approach, an anterolateral thoracotomy or by thoracoscopy.[3] The subxiphoid approach creates an external communication only and should not be called a 'window' procedure as it does not create a communication between the pericardial and pleural cavities.[4] PW by anterolateral thoracotomy provides excellent drainage but, at the cost of a large and traumatic incision, a high price to pay just for access in these sick patients. On the other hand, thoracoscopic PW procedure creates a good-sized communication between the pericardial and pleural cavities in a minimally invasive manner, without the disadvantages of thoracotomy.Despite these advantages, there are only a few series of thoracoscopic PW for recurrent pericardial effusion in the literature. The objective of this study is to evaluate the safety and feasibility of thoracoscopic PW procedure for recurrent pericardial effusion.Background:This study aimed to report the surgical outcomes and also evaluating the safety and feasibility of thoracoscopic pericardial window (PW) for recurrent pericardial effusion.This was a retrospective analysis of eight cases of recurrent pericardial effusion, managed by thoracoscopic method in a tertiary-level thoracic surgery centre over 5 years. A detailed analysis of all perioperative variables, including complications, was carried out.A total of eight patients underwent thoracoscopic PW during the study period. Males (87.5%) were predominant in the cohort. The median age was 54 years (range: 28-78 years). The median duration of symptoms was 2 months (range: 1-3 months). Tuberculosis (50%), malignancy (37.5%) and chronic kidney disease (12.5%) were the causes of recurrent effusion. All patients underwent thoracoscopic procedure with no conversions. The median operative time was 45 min (range: 40-70 min). The median effusion volume drained was 500 +/- 100 ml. The median hospital stay was 3 days (range: 2-4 days) with no post-procedural complications. All the patients had complete resolution of symptoms. No recurrence was noted in the median follow-up period of 28 months (range: 6-60 months).Thoracoscopic PW is a safe and feasible minimally invasive option in the management of recurrent pericardial effusion in selected patients. Surgical fitness, haemodynamic status and estimated survival (in malignant effusion) should be considered before the procedure.Recurrent pericardial effusion can be secondary to malignancy, tuberculosis, end-stage renal disease and collagen vascular diseases.[1,2] The severity can range from mild, asymptomatic effusion to massive effusion causing cardiac tamponade. For symptomatic pericardial effusion, either therapeutic needle pericardiocentesis or pericardial catheter drainage is indicated. However, in cases of 'failure' or 'non-feasibility' of these methods (due to the presence of multiloculations or posterior pericardial collections), 'pericardial window' (PW) is the definitive treatment option.PW is created by the removal of a part of the pericardium (partial pericardiectomy) to form a communication between the pericardium and the pleural cavity. This can be achieved through a subxiphoid approach, an anterolateral thoracotomy or by thoracoscopy.[3] The subxiphoid approach creates an external communication only and should not be called a 'window' procedure as it does not create a communication between the pericardial and pleural cavities.[4] PW by anterolateral thoracotomy provides excellent drainage but, at the cost of a large and traumatic incision, a high price to pay just for access in these sick patients. On the other hand, thoracoscopic PW procedure creates a good-sized communication between the pericardial and pleural cavities in a minimally invasive manner, without the disadvantages of thoracotomy.Despite these advantages, there are only a few series of thoracoscopic PW for recurrent pericardial effusion in the literature. The objective of this study is to evaluate the safety and feasibility of thoracoscopic PW procedure for recurrent pericardial effusion.Background:This study aimed to report the surgical outcomes and also evaluating the safety and feasibility of thoracoscopic pericardial window (PW) for recurrent pericardial effusion.This was a retrospective analysis of eight cases of recurrent pericardial effusion, managed by thoracoscopic method in a tertiary-level thoracic surgery centre over 5 years. A detailed analysis of all perioperative variables, including complications, was carried out.A total of eight patients underwent thoracoscopic PW during the study period. Males (87.5%) were predominant in the cohort. The median age was 54 years (range: 28-78 years). The median duration of symptoms was 2 months (range: 1-3 months). Tuberculosis (50%), malignancy (37.5%) and chronic kidney disease (12. 5%) were the causes of recurrent effusion. All patients underwent thoracoscopic procedure with no conversions. The median operative time was 45 min (range: 40-70 min). The median effusion volume drained was 500 +/- 100 ml. The median hospital stay was 3 days (range: 2-4 days) with no post-procedural complications. All the patients had complete resolution of symptoms. No recurrence was noted in the median follow-up period of 28 months (range: 6-60 months).Thoracoscopic PW is a safe and feasible minimally invasive option in the management of recurrent pericardial effusion in selected patients. Surgical fitness, haemodynamic status and estimated survival (in malignant effusion) should be considered before the procedure.Recurrent pericardial effusion can be secondary to malignancy, tuberculosis, end-stage renal disease and collagen vascular diseases.[1,2] The severity can range from mild, asymptomatic effusion to massive effusion causing cardiac tamponade. For symptomatic pericardial effusion, either therapeutic needle pericardiocentesis or pericardial catheter drainage is indicated. However, in cases of 'failure' or 'non-feasibility' of these methods (due to the presence of multiloculations or posterior pericardial collections), 'pericardial window' (PW) is the definitive treatment option.PW is created by the removal of a part of the pericardium (partial pericardiectomy) to form a communication between the pericardium and the pleural cavity. This can be achieved through a subxiphoid approach, an anterolateral thoracotomy or by thoracoscopy.[3] The subxiphoid approach creates an external communication only and should not be called a 'window' procedure as it does not create a communication between the pericardial and pleural cavities.[4] PW by anterolateral thoracotomy provides excellent drainage but, at the cost of a large and traumatic incision, a high price to pay just for access in these sick patients. On the other hand, thoracoscopic PW procedure creates a good-sized communication between the pericardial and pleural cavities in a minimally invasive manner, without the disadvantages of thoracotomy.Despite these advantages, there are only a few series of thoracoscopic PW for recurrent pericardial effusion in the literature. The objective of this study is to evaluate the safety and feasibility of thoracoscopic PW procedure for recurrent pericardial effusion.Background:This study aimed to report the surgical outcomes and also evaluating the safety and feasibility of thoracoscopic pericardial window (PW) for recurrent pericardial effusion.This was a retrospective analysis of eight cases of recurrent pericardial effusion, managed by thoracoscopic method in a tertiary-level thoracic surgery centre over 5 years. A detailed analysis of all perioperative variables, including complications, was carried out.A total of eight patients underwent thoracoscopic PW during the study period. Males (87.5%) were predominant in the cohort. The median age was 54 years (range: 28-78 years). The median duration of symptoms was 2 months (range: 1-3 months). Tuberculosis (50%), malignancy (37.5%) and chronic kidney disease (12.5%) were the causes of recurrent effusion. All patients underwent thoracoscopic procedure with no conversions. The median operative time was 45 min (range: 40-70 min). The median effusion volume drained was 500 +/- 100 ml. The median hospital stay was 3 days (range: 2-4 days) with no post-procedural complications. All the patients had complete resolution of symptoms. No recurrence was noted in the median follow-up period of 28 months (range: 6-60 months).Thoracoscopic PW is a safe and feasible minimally invasive option in the management of recurrent pericardial effusion in selected patients. Surgical fitness, haemodynamic status and estimated survival (in malignant effusion) should be considered before the procedure.Recurrent pericardial effusion can be secondary to malignancy, tuberculosis, end-stage renal disease and collagen vascular diseases.[1,2] The severity can range from mild, asymptomatic effusion to massive effusion causing cardiac tamponade. For symptomatic pericardial effusion, either therapeutic needle pericardiocentesis or pericardial catheter drainage is indicated. However, in cases of 'failure' or 'non-feasibility' of these methods (due to the presence of multiloculations or posterior pericardial collections), 'pericardial window' (PW) is the definitive treatment option.PW is created by the removal of a part of the pericardium (partial pericardiectomy) to form a communication between the pericardium and the pleural cavity. This can be achieved through a subxiphoid approach, an anterolateral thoracotomy or by thoracoscopy.[3] The subxiphoid approach creates an external communication only and should not be called a 'window' procedure as it does not create a communication between the pericardial and pleural cavities.[4] PW by anterolateral thoracotomy provides excellent drainage but, at the cost of a large and traumatic incision, a high price to pay just for access in these sick patients. On the other hand, thoracoscopic PW procedure creates a good-sized communication between the pericardial and pleural cavities in a minimally invasive manner, without the disadvantages of thoracotomy.Despite these advantages, there are only a few series of thoracoscopic PW for recurrent pericardial effusion in the literature. The objective of this study is to evaluate the safety and feasibility of thoracoscopic PW procedure for recurrent pericardial effusion.Background:This study aimed to report the surgical outcomes and also evaluating the safety and feasibility of thoracoscopic pericardial window (PW) for recurrent pericardial effusion.This was a retrospective analysis of eight cases of recurrent pericardial effusion, managed by thoracoscopic method in a tertiary-level thoracic surgery centre over 5 years. A detailed analysis of all perioperative variables, including complications, was carried out.A total of eight patients underwent thoracoscopic PW during the study period. Males (87.5%) were predominant in the cohort. The median age was 54 years (range: 28-78 years). The median duration of symptoms was 2 months (range: 1-3 months). Tuberculosis (50%), malignancy (37.5%) and chronic kidney disease (12.5%) were the causes of recurrent effusion. All patients underwent thoracoscopic procedure with no conversions. The median operative time was 45 min (range: 40-70 min). The median effusion volume drained was 500 +/- 100 ml. The median hospital stay was 3 days (range: 2-4 days) with no post-procedural complications. All the patients had complete resolution of symptoms. No recurrence was noted in the median follow-up period of 28 months (range: 6-60 months).Thoracoscopic PW is a safe and feasible minimally invasive option in the management of recurrent pericardial effusion in selected patients. Surgical fitness, haemodynamic status and estimated survival (in malignant effusion) should be considered before the procedure. Recurrent pericardial effusion can be secondary to malignancy, tuberculosis, end-stage renal disease and collagen vascular diseases.[1,2] The severity can range from mild, asymptomatic effusion to massive effusion causing cardiac tamponade. For symptomatic pericardial effusion, either therapeutic needle pericardiocentesis or pericardial catheter drainage is indicated. However, in cases of 'failure' or 'non-feasibility' of these methods (due to the presence of multiloculations or posterior pericardial collections), 'pericardial window' (PW) is the definitive treatment option.PW is created by the removal of a part of the pericardium (partial pericardiectomy) to form a communication between the pericardium and the pleural cavity. This can be achieved through a subxiphoid approach, an anterolateral thoracotomy or by thoracoscopy.[3] The subxiphoid approach creates an external communication only and should not be called a 'window' procedure as it does not create a communication between the pericardial and pleural cavities.[4] PW by anterolateral thoracotomy provides excellent drainage but, at the cost of a large and traumatic incision, a high price to pay just for access in these sick patients. On the other hand, thoracoscopic PW procedure creates a good-sized communication between the pericardial and pleural cavities in a minimally invasive manner, without the disadvantages of thoracotomy.Despite these advantages, there are only a few series of thoracoscopic PW for recurrent pericardial effusion in the literature. The objective of this study is to evaluate the safety and feasibility of thoracoscopic PW procedure for recurrent pericardial effusion.Background:This study aimed to report the surgical outcomes and also evaluating the safety and feasibility of thoracoscopic pericardial window (PW) for recurrent pericardial effusion.This was a retrospective analysis of eight cases of recurrent pericardial effusion, managed by thoracoscopic method in a tertiary-level thoracic surgery centre over 5 years. A detailed analysis of all perioperative variables, including complications, was carried out.A total of eight patients underwent thoracoscopic PW during the study period. Males (87.5%) were predominant in the cohort. The median age was 54 years (range: 28-78 years). The median duration of symptoms was 2 months (range: 1-3 months). Tuberculosis (50%), malignancy (37.5%) and chronic kidney disease (12.5%) were the causes of recurrent effusion. All patients underwent thoracoscopic procedure with no conversions. The median operative time was 45 min (range: 40-70 min). The median effusion volume drained was 500 +/- 100 ml. The median hospital stay was 3 days (range: 2-4 days) with no post-procedural complications. All the patients had complete resolution of symptoms. No recurrence was noted in the median follow-up period of 28 months (range: 6-60 months).Thoracoscopic PW is a safe and feasible minimally invasive option in the management of recurrent pericardial effusion in selected patients. Surgical fitness, haemodynamic status and estimated survival (in malignant effusion) should be considered before the procedure.Recurrent pericardial effusion can be secondary to malignancy, tuberculosis, end-stage renal disease and collagen vascular diseases.[1,2] The severity can range from mild, asymptomatic effusion to massive effusion causing cardiac tamponade. For symptomatic pericardial effusion, either therapeutic needle pericardiocentesis or pericardial catheter drainage is indicated. However, in cases of 'failure' or 'non-feasibility' of these methods (due to the presence of multiloculations or posterior pericardial collections), 'pericardial window' (PW) is the definitive treatment option.PW is created by the removal of a part of the pericardium (partial pericardiectomy) to form a communication between the pericardium and the pleural cavity. This can be achieved through a subxiphoid approach, an anterolateral thoracotomy or by thoracoscopy.[3] The subxiphoid approach creates an external communication only and should not be called a 'window' procedure as it does not create a communication between the pericardial and pleural cavities.[4] PW by anterolateral thoracotomy provides excellent drainage but, at the cost of a large and traumatic incision, a high price to pay just for access in these sick patients. On the other hand, thoracoscopic PW procedure creates a good-sized communication between the pericardial and pleural cavities in a minimally invasive manner, without the disadvantages of thoracotomy.Despite these advantages, there are only a few series of thoracoscopic PW for recurrent pericardial effusion in the literature. The objective of this study is to evaluate the safety and feasibility of thoracoscopic PW procedure for recurrent pericardial effusion.Background:This study aimed to report the surgical outcomes and also evaluating the safety and feasibility of thoracoscopic pericardial window (PW) for recurrent pericardial effusion.This was a retrospective analysis of eight cases of recurrent pericardial effusion, managed by thoracoscopic method in a tertiary-level thoracic surgery centre over 5 years. A detailed analysis of all perioperative variables, including complications, was carried out.A total of eight patients underwent thoracoscopic PW during the study period. Males (87.5%) were predominant in the cohort. The median age was 54 years (range: 28-78 years). The median duration of symptoms was 2 months (range: 1-3 months). Tuberculosis (50%), malignancy (37.5%) and chronic kidney disease (12.5%) were the causes of recurrent effusion. All patients underwent thoracoscopic procedure with no conversions. The median operative time was 45 min (range: 40-70 min). The median effusion volume drained was 500 +/- 100 ml. The median hospital stay was 3 days (range: 2-4 days) with no post-procedural complications. All the patients had complete resolution of symptoms. No recurrence was noted in the median follow-up period of 28 months (range: 6-60 months).Thoracoscopic PW is a safe and feasible minimally invasive option in the management of recurrent pericardial effusion in selected patients. Surgical fitness, haemodynamic status and estimated survival (in malignant effusion) should be considered before the procedure.Recurrent pericardial effusion can be secondary to malignancy, tuberculosis, end-stage renal disease and collagen vascular diseases.[1,2] The severity can range from mild, asymptomatic effusion to massive effusion causing cardiac tamponade. For symptomatic pericardial effusion, either therapeutic needle pericardiocentesis or pericardial catheter drainage is indicated. However, in cases of 'failure' or 'non-feasibility' of these methods (due to the presence of multiloculations or posterior pericardial collections), 'pericardial window' (PW) is the definitive treatment option.PW is created by the removal of a part of the pericardium (partial pericardiectomy) to form a communication between the pericardium and the pleural cavity. This can be achieved through a subxiphoid approach, an anterolateral thoracotomy or by thoracoscopy.[3] The subxiphoid approach creates an external communication only and should not be called a 'window' procedure as it does not create a communication between the pericardial and pleural cavities.[4] PW by anterolateral thoracotomy provides excellent drainage but, at the cost of a large and traumatic incision, a high price to pay just for access in these sick patients. On the other hand, thoracoscopic PW procedure creates a good-sized communication between the pericardial and pleural cavities in a minimally invasive manner, without the disadvantages of thoracotomy.Despite these advantages, there are only a few series of thoracoscopic PW for recurrent pericardial effusion in the literature. The objective of this study is to evaluate the safety and feasibility of thoracoscopic PW procedure for recurrent pericardial effusion.