Title: Minimally Invasive Surgery for Pericardial Effusion and Tamponade
1Minimally Invasive Surgery for Pericardial
Effusion and Tamponade
- Partial pericardiectomy
- Hemostasis
- Chest tube drainage
Pericardial window
2Thoracoscopic Pericardiectomy for Malignant
EffusionSurvival in Months
3Thoracoscopic PericardiectomySurvival in Months
N22
4Malignant Pericardial EffusionComparative
Survival
5Malignant Pericardial Effusion Comparative
Survival Breast CA
6Malignant Pericardial Effusion Comparative
Survival Lung CA (NSC)
7Conclusion
- Thoracoscopic pericardiectomy is a
- Simple
- Safe
- Effective
- technique for the management of malignant
pericardial effusion and tamponade
8Pleural Effusion
Inverts the diaphragm, so thoracic cavity gets
smaller with inspiration L2 dyspnea
- Very common clinical problem.
- Starling forces
- DDx by Light criteria
- Sp. Gr., protein, glucose, LDH, cultures
- Pleural Bx gt thoracoscopy
- DOE caused by paradoxical diaphragm
- Rx depends upon Dx
Always do a pleurocentesis
9Malignant Pleural Effusion
Almost never a transudate
Any CA can cause this, but most common w/
- Very common clinical problem in tumors that
involve thoracic nodes - LunggtBreastgtLymphoma.
- Short survival
- Adverse QOL
- Effective palliative Rx is currently by
pleurodesis.
Stick parietal w/ visceral pleura
10Thoracoscopy
Tumor nodule
- Minimally invasive technology
- Better visualization of intrathoracic structures
- Limited palpation
- Technical Limitations
- Technology is in evolution
- Diagnostic
- Therapeutic
- benign nodules and mediastinal tumors
- metastases
- lung CA? Nope
11Pleurodesis
- Instill a substance into the pleura that causes
inflammation and symphysis of the visceral and
parietal pleura. - No residual space is left for recurrence of
effusion.
- Chest tube alone lt40
- Tetra-Doxycycline
- lt 60
- Bleomycin better than Doxy but .
- Talc lt70-90
- slurry
- powder via thoracoscope
Cheap like mud
12PleurX Catheter
For pleurodesis
Other Tx can be given thru this catheter
- New technique
- Outpatient placement of silastic cuffed catheter.
- Outpatient drainage of recurrent pleural effusion
for palliation.
catheter
13Chylothorax
- Leakage of chyle from a defect in the thoracic
duct. - High fat, protein loss.
- Death by starvation.
- Etiology
- congenital
- trauma
- tumor
- Rx thoracic duct ligation
Usu. milky white liquid
Tx