Recommendations For Overcoming Difficulties In Video-Assisted Thoracoscopic Pericardial Fenestration

Purpose: Pericardial fenestration is used to treat recurrent pericardial effusion. This study aimed to assess the issues and solutions in pericardio-pleural fenestration (PPF) applications using video-assisted thoracoscopic surgery (VATS), which is more prominent today. Materials and Methods: Between July 2018 and December 2020, a total of 8 patients (3 males, 5 females; median age: 51.8 years, range: 23–65 years), who underwent VATS PPF in the Ondokuz Mayıs University Faculty of Medicine, were retrospectively evaluated using the hospital database and the findings were compared with the results reported in previous literature. Results: The amount of pericardial fluid drained and the measurement of fluid next to the inferior wall on echocardiography had a statistically significant positive and high correlation (p=.032). Shorter surgical time was correlated with the right lateral 45° position and single port interventions (p=.020). The average time to remove the chest tube was 3.1 days (min: 2.0-max: 7.0), and the average time to discharge was 6.1 days (min: 3.0-max: 10.0). Conclusion: VATS PPF conducted through the 4th intercostal space with a single port in the right lateral 45° position is a procedure that can be safely used in patients with recurrent pericardial effusion, despite the type of therapy.