THORACOSCOPIC AF ABLATION IN AN EXTREMELY OBESE PATIENT
Egor Malyshenko, Vadim Popov, Maxim Novikov, Magomed Gasangusenov, Amiran Revishvili.
A.V.Visnevskiy National research center of surgery, Moscow, Russian Federation.
BACKGROUND: Thoracoscopic AF ablation is particularly difficult to perform in some clinical situations. One of these situations is the severe obesity of the patient. The presence of an extremely elevated BMI appears to be a contraindication to thoracoscopic AF ablation.METHODS: A case of successful AF ablation in a 59-year-old female patient with severe obesity (BMI 42 kg / m2) is presented. In this case, there were 3 previous unsuccessful catheter AF ablation and 1 unsuccessful cryoballoon ablation. Immediately after endoscopic access to the right pleural cavity, it was not possible to visualize the mediastinal pericardial layer and the right phrenic nerve due to pronounced excess mediastinal adipose tissue. It was decided to refrain from massive resection of the adipose mediastinal tissue and to use the technique of multiple stay with Teflon strips. RESULTS: The placing of multiple stay sutures took 20 minutes and allowed to obtain good visualization of the mediastinal pericardium and the right phrenic nerve (see the Fig.), as well as to completely avoid the need for extensive resection of fat. This maneuver made it possible to reduce the trauma and duration of the operation and reduce the risk of bleeding. CONCLUSIONS: The application of multiple stay sutures with teflon strips technique allows achieving good visualization of the surgical area during thoracoscopic AF ablation reducing the operation time and the risk of bleeding. 
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