Robotic Endoscopic Off-Pump Total Pericardiectomy in Constrictive Pericarditis

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Procedures
• Robotic-Assisted Surgery

Background:

• Constrictive pericarditis is a serious condition causing heart failure, with total pericardiectomy being the primary treatment.
• Traditional median sternotomy for pericardiectomy offers complete exposure but is invasive.
• Thoracoscopic partial pericardiectomy has limitations in exposure and identifying critical structures like phrenic nerves.

Observation:

• Four patients with constrictive pericarditis underwent robotic-assisted off-pump total pericardiectomy.
• The procedure utilized a left chest approach with CO2 insufflation for enhanced visualization and exposure.
• Careful dissection around both phrenic nerves was achieved using robotic instruments and a stabilizer.

Findings:

• Robotic total pericardiectomy provided superior visualization of phrenic nerves, preventing injury.
• The technique allowed for a complete and thorough pericardial dissection, superior to thoracoscopy.
• Patients experienced rapid recovery, with two extubated within 6 hours and discharged by postoperative day 5.

Implications:

• Robotic surgery is a viable and effective alternative for total pericardiectomy in constrictive pericarditis.
• This approach enhances surgical precision and safety, particularly in relation to phrenic nerve preservation.
• The robotic left chest approach may be more efficacious for posterior pericardium removal than sternotomy.