Laparoscopic transabdominal pericardial window: new standard in the treatment of recurrent pericardial effusion complicated by cardiac tamponade.

Creation of a transabdominal transdiaphragmatic pericardial window for life-threatening recurrent pericardial effusion has proved to be a safe minimally invasive technique. By inducing adequate pericardial sac decompression while avoiding single-lung ventilation and thoracic drainage in severely ill patients, it provides anatomopathologic diagnosis and can direct further therepeutic measures. The transabdominal approach improves postoperative recovery dramatically by limiting postoperative pain and prevents sometimes invalidating intercostal neuralgia. Transabdominal pericardial sac fenestration should be part of the armamentarium used by every minimally invasive surgeon.