Thoracoscopic subphrenic pericardectomy using double-lumen endobronchial intubation for alternating one-lung ventilation

Kelli N. Mayhew, Philipp Mayhew, Laurie Sorrell-Raschi, Dorothy Cimino Brown

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Objective To report the technique, complications, and effectiveness of thoracoscopic subphrenic pericardectomy (SPP) using double-lumen endobronchial intubation for alternating 1-lung (OLV) in healthy dogs. Study Design Prospective cohort study. Animals Mature purpose-bred dogs (n=7). Methods Bronchoscope-assisted placement of a left-sided double-lumen endobronchial tube, immediately before surgery, allowed intraoperative alternation of ventilation between lung fields. A camera portal was established in a subxyphoid location. Two instrument portals were established at the 4th-6th intercostal spaces on the right and left sides. A vessel-sealing device was used to create the subphrenic pericardectomy. After termination of the procedure, dogs were humanely euthanatized under anesthesia and necropsy performed. In each dog, the extent of pericardectomy and any complications were evaluated. Results - Technical difficulties with tube placement occurred in 4 dogs, but alternating OLV was achieved in all dogs and SPP completed successfully. Median surgical time was 87.5 minutes (range, 80-105 minutes). At necropsy, 0.5-2 cm of pericardial tissue remained ventral to the intact phrenic nerve in 6 dogs; in 1 dog, the phrenic nerve was transected on the left side only. Conclusions - Thoracoscopic subphrenic pericardectomy is a technically feasible procedure in healthy dogs. Double-lumen endobronchial intubation allowed alternating OLV without intraoperative bronchoscopically guided tube manipulation in all but 1 dog. Clinical Relevance - Thoracoscopic subphrenic pericardectomy could potentially be used for management of conditions where relief of pericardial constriction or access to intrapericardial structures is desired.

Original languageEnglish (US)
Pages (from-to)961-966
Number of pages6
JournalVeterinary Surgery
Volume38
Issue number8
DOIs
StatePublished - Dec 2009
Externally publishedYes

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One-Lung Ventilation
Pericardiectomy
Intubation
breathing
Dogs
dogs
Phrenic Nerve
necropsy
nerve tissue
lungs
Bronchoscopes
Lung
dog breeds
cohort studies
cameras
Operative Time
Constriction
anesthesia
Ventilation
surgery

ASJC Scopus subject areas

  • veterinary(all)

Cite this

Thoracoscopic subphrenic pericardectomy using double-lumen endobronchial intubation for alternating one-lung ventilation. / Mayhew, Kelli N.; Mayhew, Philipp; Sorrell-Raschi, Laurie; Cimino Brown, Dorothy.

In: Veterinary Surgery, Vol. 38, No. 8, 12.2009, p. 961-966.

Research output: Contribution to journalArticle

Mayhew, Kelli N. ; Mayhew, Philipp ; Sorrell-Raschi, Laurie ; Cimino Brown, Dorothy. / Thoracoscopic subphrenic pericardectomy using double-lumen endobronchial intubation for alternating one-lung ventilation. In: Veterinary Surgery. 2009 ; Vol. 38, No. 8. pp. 961-966.
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abstract = "Objective To report the technique, complications, and effectiveness of thoracoscopic subphrenic pericardectomy (SPP) using double-lumen endobronchial intubation for alternating 1-lung (OLV) in healthy dogs. Study Design Prospective cohort study. Animals Mature purpose-bred dogs (n=7). Methods Bronchoscope-assisted placement of a left-sided double-lumen endobronchial tube, immediately before surgery, allowed intraoperative alternation of ventilation between lung fields. A camera portal was established in a subxyphoid location. Two instrument portals were established at the 4th-6th intercostal spaces on the right and left sides. A vessel-sealing device was used to create the subphrenic pericardectomy. After termination of the procedure, dogs were humanely euthanatized under anesthesia and necropsy performed. In each dog, the extent of pericardectomy and any complications were evaluated. Results - Technical difficulties with tube placement occurred in 4 dogs, but alternating OLV was achieved in all dogs and SPP completed successfully. Median surgical time was 87.5 minutes (range, 80-105 minutes). At necropsy, 0.5-2 cm of pericardial tissue remained ventral to the intact phrenic nerve in 6 dogs; in 1 dog, the phrenic nerve was transected on the left side only. Conclusions - Thoracoscopic subphrenic pericardectomy is a technically feasible procedure in healthy dogs. Double-lumen endobronchial intubation allowed alternating OLV without intraoperative bronchoscopically guided tube manipulation in all but 1 dog. Clinical Relevance - Thoracoscopic subphrenic pericardectomy could potentially be used for management of conditions where relief of pericardial constriction or access to intrapericardial structures is desired.",
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