Subxiphoid Mediastinoscopic Autonomous Double Fenestration

Abstract

The coexistence of pleural and pericardial effusions in frail patients with or without confirmed neoplasia necessitates the use of a minimally invasive technique that has a minor impact on the patient's general status and allows for fast fluid evacuation and biopsy sampling if necessary. We present a subxiphoid mediastinoscopic autonomous (simultaneous noncommunicating) double fenestration approach for these patients with both diagnostic and therapeutic advantages in selected cases. Using the mediastinoscope alone through the subxiphoid incision can considerably reduce the duration of operation, allow for fluid evacuation, and significantly alleviate the patient's symptoms. This method enables the sampling of pleural and pericardial fluids and targeted tissue, if necessary.

Keywords

pleuropericardial effusion - subxiphoid mediastinoscopic approach - autonomous double fenestration

Informed Consent Statement

Written informed consent has been obtained from the patients to publish this paper.

Publikationsverlauf

Eingereicht: 10. Mai 2022

Angenommen: 15. August 2022

Artikel online veröffentlicht:
10. Oktober 2022

• References

• 1 Adler Y, Charron P, Imazio M. et al; Società Europea di Cardiologia, Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC). 2015 ESC Guidelines for the diagnosis and management of pericardial diseases [in Italian]. G Ital Cardiol (Rome) 2015; 16 (12) 702-738
• 2 Imazio M. Noninfectious pericarditis: management challenges for cardiologists. Kardiol Pol 2020; 78 (05) 396-403
• 3 Ciuche A, Nistor C, Motaş C, Horvat T. Chirurgia miniinvazivă în tratamentul pleuro-pericarditelor maligne. [Minimally invasive surgery in the treatment of malignant pleuro-pericardial effusions] Chirurgia (Bucur) 2012; 107 (02) 206-212
• 4 Nistor C-E, Găvan CS, Ciritel A-A, Nemes AF, Ciuche A. The association of minimally invasive surgical approaches and mortality in patients with malignant pleuropericarditis-a 10 year retrospective observational study. Medicina (Kaunas) 2022; 58 (06) 718
• 5 Nistor Cl, Ranetti AE, Ciuche A, Pantile D, Constantin LM, Brincoveanu R. Betadine® in chemical pleurodesis. Farmacia 2014; 62 (05) 897-906
• 6 Ricciardi S, Jaus MO. Cardillo G. Possibilities of surgical pleurodesis for malignant pleural effusion. AME Med J 2020; 5: 20
• 7 Koegelenberg CFN, Shaw JA, Irusen EM, Lee YCG. Contemporary best practice in the management of malignant pleural effusion. Ther Adv Respir Dis 2018; 12: 1753466618785098
• 8 Porcel JM, Lui MM, Lerner AD, Davies HE, Feller-Kopman D, Lee YC. Comparing approaches to the management of malignant pleural effusions. Expert Rev Respir Med 2017; 11 (04) 273-284
• 9 Barone A, Prioletta M, Cipollone G, Nuzzo D, Camplese P, Mucilli F. Surgical management of cardiac tamponade: is left anterior minithoracotomy really safe and effective?. J Emerg Pract Trauma 2017; 3 (02) 53-58
• 10 Nistor C, Ciuche A, Davidescu M, Horvat T. Pleurotomy–an operation by the general surgeon [in Romanian]. Chirurgia (Bucur) 2009; 104 (03) 323-328
• 11 Carlens E. Author. Mediastinoscopy: a method for inspection and tissue biopsy in the superior mediastinum. Dis Chest 1959; 36: 343-352
• 12 Mack MJ, Landreneau RJ, Hazelrigg SR, Acuff TE. Video thoracoscopic management of benign and malignant pericardial effusions. Chest 1993; 103 (4, Suppl): 390S-393S
• 13 Santos GH, Frater RW. The subxiphoid approach in the treatment of pericardial effusion. Ann Thorac Surg 1977; 23 (05) 467-470