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IN a paper summarised on p 95 in this issue of Veterinary Record, De Ridder and others (2016) describe a novel abdominal transdiaphragmatic approach for subtotal pericardiectomy in dogs. The authors compare their novel transdiaphragmatic approach to a right fifth intercostal approach in a series of small and large breed dog cadavers. The study also includes details of the outcomes in nine clinical cases in which pericardiectomy was performed through a transdiaphragmatic approach. In small cadavers the intercostal and transdiaphragmatic approaches removed the same percentage of pericardium; in large cadavers a significantly higher percentage of pericardium was removed with the intercostal approach compared to the transdiaphragmatic approach. All of the dogs in the clinical case series survived surgery, did not experience complications and their coeliotomy incisions healed. The authors concluded that the transdiaphragmatic technique was safe, potentially more appealing to owners and less technically challenging compared to an intercostal approach. However, the study found a reduction in exposure, when using the transdiaphragmatic technique, especially to the heart base. Additional lighting, either with a thoracoscope or a headlamp, was often required.
Classical open pericardiectomy techniques are either through a right fifth intercostal thoracotomy or a median sternotomy. Median sternotomy offers the best exposure, but is the most invasive approach …