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Levine et al: Intercostal thoracoscopic pericardiectomy in left lateral recumbency: A cadaveric study of feasibility, efficiency, and extent of pericardial resection
Veterinary Surgery 1, 2025

🔍 Key Findings

Study design: Randomized cadaveric comparison (n=20 dogs; ILR vs PDR)

Approaches:

  • ILR = Intercostal in Left Lateral Recumbency (no OLV required)
  • PDR = Paraxiphoid in Dorsal Recumbency (traditional)

Outcomes:

  • Pericardiectomy time was shorter for ILR (p = .045)
  • Pericardial fragment size was significantly larger in PDR group (p = .004; 23.21 cm² difference)
  • Visibility and cardiac exposure were superior in PDR group

Feasibility:

  • ILR approach was consistently successful in achieving partial pericardiectomy
  • Bilateral ventilation was adequate; no need for OLV

Clinical relevance:

  • ILR may improve efficiency when paired with TDL
  • PDR remains preferable for cases requiring maximal pericardial resection
Intercostal thoracoscopic pericardiectomy in left lateral recumbency: A cadaveric study of feasibility, efficiency, and extent of pericardial resection
Intercostal thoracoscopic pericardiectomy in left lateral recumbency: A cadaveric study of feasibility, efficiency, and extent of pericardial resection
Intercostal thoracoscopic pericardiectomy in left lateral recumbency: A cadaveric study of feasibility, efficiency, and extent of pericardial resection
Intercostal thoracoscopic pericardiectomy in left lateral recumbency: A cadaveric study of feasibility, efficiency, and extent of pericardial resection
Intercostal thoracoscopic pericardiectomy in left lateral recumbency: A cadaveric study of feasibility, efficiency, and extent of pericardial resection
Intercostal thoracoscopic pericardiectomy in left lateral recumbency: A cadaveric study of feasibility, efficiency, and extent of pericardial resection
Intercostal thoracoscopic pericardiectomy in left lateral recumbency: A cadaveric study of feasibility, efficiency, and extent of pericardial resection
Intercostal thoracoscopic pericardiectomy in left lateral recumbency: A cadaveric study of feasibility, efficiency, and extent of pericardial resection
Intercostal thoracoscopic pericardiectomy in left lateral recumbency: A cadaveric study of feasibility, efficiency, and extent of pericardial resection
Intercostal thoracoscopic pericardiectomy in left lateral recumbency: A cadaveric study of feasibility, efficiency, and extent of pericardial resection
Intercostal thoracoscopic pericardiectomy in left lateral recumbency: A cadaveric study of feasibility, efficiency, and extent of pericardial resection
Intercostal thoracoscopic pericardiectomy in left lateral recumbency: A cadaveric study of feasibility, efficiency, and extent of pericardial resection

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← Articles

Levine et al: Intercostal thoracoscopic pericardiectomy in left lateral recumbency: A cadaveric study of feasibility, efficiency, and extent of pericardial resection
Veterinary Surgery 1, 2025

🔍 Key Findings

Study design: Randomized cadaveric comparison (n=20 dogs; ILR vs PDR)

Approaches:

  • ILR = Intercostal in Left Lateral Recumbency (no OLV required)
  • PDR = Paraxiphoid in Dorsal Recumbency (traditional)

Outcomes:

  • Pericardiectomy time was shorter for ILR (p = .045)
  • Pericardial fragment size was significantly larger in PDR group (p = .004; 23.21 cm² difference)
  • Visibility and cardiac exposure were superior in PDR group

Feasibility:

  • ILR approach was consistently successful in achieving partial pericardiectomy
  • Bilateral ventilation was adequate; no need for OLV

Clinical relevance:

  • ILR may improve efficiency when paired with TDL
  • PDR remains preferable for cases requiring maximal pericardial resection

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Multiple Choice Questions on this study

In Levine 2025 et al., on thoracoscopic pericardiectomy, which approach avoided the need for one-lung ventilation?

A. Paraxiphoid in dorsal recumbency (PDR)
B. Thoracotomy via left fifth intercostal space
C. Transsternal thoracoscopy
D. Intercostal in left lateral recumbency (ILR)
E. Mediastinal pericardial window

Answer: Intercostal in left lateral recumbency (ILR)

Explanation: ILR enabled bilateral ventilation and avoided the need for OLV.
In Levine 2025 et al., on thoracoscopic pericardiectomy, what was the main efficiency advantage of the ILR approach?

A. Shorter operative time
B. Better cardiac exposure
C. Greater resection width
D. Easier closure technique
E. Lower risk of hemorrhage

Answer: Shorter operative time

Explanation: ILR had a significantly shorter pericardiectomy time than PDR (p = .045).
In Levine 2025 et al., on thoracoscopic pericardiectomy, which approach may offer benefit when paired with thoracic duct ligation (TDL)?

A. Median sternotomy
B. PDR
C. Transdiaphragmatic thoracoscopy
D. ILR
E. Bilateral thoracotomy

Answer: ILR

Explanation: ILR improves efficiency and could facilitate simultaneous TDL.
In Levine 2025 et al., on thoracoscopic pericardiectomy, which approach produced the largest pericardial resection?

A. Intercostal in lateral recumbency (ILR)
B. Left intercostal via ventral midline
C. Paraxiphoid in dorsal recumbency (PDR)
D. Transdiaphragmatic thoracoscopy
E. Left-sided thoracotomy

Answer: Paraxiphoid in dorsal recumbency (PDR)

Explanation: PDR achieved significantly larger pericardial fragment sizes (mean difference = 23.21 cm², p = .004).
In Levine 2025 et al., on thoracoscopic pericardiectomy, which statement best describes cardiac exposure between groups?

A. Exposure was equivalent
B. Exposure was better in ILR
C. PDR had superior cardiac exposure
D. ILR allowed visualization of both atria
E. ILR caused atrial obscuration

Answer: PDR had superior cardiac exposure

Explanation: PDR approach offered more comprehensive cardiac visibility.

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