CPT® Code 32660

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The procedure described by CPT® Code 32660 involves a surgical thoracoscopy, specifically a total pericardiectomy. This surgical technique is utilized to address conditions affecting the pericardium, which is the fibrous membrane encasing the heart. During the procedure, the physician creates a pericardial window or performs a partial resection of the pericardial sac to facilitate drainage. The approach typically involves making a small incision between the ribs, often at the sixth or seventh intercostal space along the anterior axillary line, through which a videothoracoscope is introduced. This minimally invasive technique allows for enhanced visualization and access to the pericardial space. To perform the total pericardiectomy, additional incisions are made at the posterior axillary line, usually at the fifth and eighth intercostal spaces, to accommodate the surgical instruments necessary for the procedure. The inferior pulmonary ligament is divided to gain better access, and the phrenic nerve, which is crucial for diaphragm function, is carefully identified and protected throughout the operation. The pericardium is then grasped and retracted away from the heart, allowing the surgeon to use endoscopic scissors to make an incision in the pericardium. This incision facilitates the evacuation of blood and fluid from the pericardial space. The procedure may involve resecting a section of the pericardial sac, typically measuring three to four centimeters, to create a pericardial window or to perform a more extensive resection. The pericardium is examined, and a sponge may be introduced to break up any loculations present. If necessary, a second window can be created using the same technique. To ensure proper drainage post-surgery, a chest tube is placed into the pericardial window, and an additional chest tube is inserted into the pleural space. The total pericardiectomy is completed by resecting the pericardium as extensively as possible, followed by the placement of chest tubes and closure of the incisions. This procedure is critical for managing conditions that lead to fluid accumulation or other complications within the pericardial space.