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Single-port thoracoscopic monitoring of laser-assisted lead extraction
Patrick Zardo, Bernhard Fleischer, Henning Busk, Ingo Kutschka.
Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.

OBJECTIVE: Extensive vascular laceration is a rare but potentially fatal complication of laser-assisted pacemaker and/or AICD lead-extraction. We aimed to achieve direct visual control over all critical steps of the procedure through intraoperative thoracoscopic monitoring.
METHODS: Insertion of a 5mm/30° thoracoscope in single-port-technique through the 5th intercostal space on the right side and real-time video-monitoring of the excimer-laser-assisted, sheath-guided lead extraction.
RESULTS: Thoracoscope insertion allows for good exposure and real-time monitoring of all critical vascular structures, including the superior vena cava and the innominate vein. Non-critical, beginning laceration can be detected early, further lead extraction paused and bleeding site control achieved through this approach.
CONCLUSIONS: Even though vascular laceration in laser-assisted lead extraction is rare, we recommend direct video-assisted monitoring in high-risk-cases to facilitate rapid intervention when and if this potentially fatal complication arises.

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