Page 200 - Clinical Manual of Small Animal Endosurgery

188 Clinical Manual of Small Animal Endosurgery

(a)

(b)

Fig. 6.10 After larger vessels are sealed with bipolar electrocautery (a),
the ventral mediastinum is cut close to the sternum (b). While haemorrhage
from these vessels is likely to be clinically insignificant, dripping blood
tends to soil the endoscope’s distal lens and hamper good visualisation.

adhesions may complicate a thoracoscopic subtotal pericardiectomy, and
a partial pericardiectomy may instead need to be pursued. The pericar-
dium is then incised laterally towards the heart base, paying attention to
avoid the phrenic nerves and vagus. The incision is subsequently extended
cranially, taking great care to avoid inadvertent incision into the atrial
appendage or edges of the right cranial lung, and then extended on the
contralateral side. Lastly the caudal portion of the pericardium is incised,
ventral to the vena cava (Fig. 6.16). Adequate visualisation can be
achieved by alternating the endoscope and instruments between the dif-
ferent ports, depending on the section of pericardium being incised. A
second pair of grasping forceps is useful in manipulating and tensioning