A comparison of bronchial blocker under artificial pneumothorax and double-lumen endobronchial tube for lung isolation in thoracoscopic enucleation of oesophageal leiomyoma

Large isolated fibrous tumors in the upper esophagus: A case report

BACKGROUND

Solitary fibrous tumors (SFT) are rare spindle cell tumors that are usually benign. A total of 10 cases of SFTs in the upper esophagus have ever been reported. Here, we report the anesthetic management of a patient with a large isolated fibrous tumor of the upper esophagus compressing the tracheal membrane. We also provide a literature review of the current research.

CASE SUMMARY

We report the case of a 49 year old male with "cough aggravation and wheezing after exercise", who underwent esophagectomy for a large isolated fibrous tumor compressing the tracheal membrane in the upper esophagus. We advise the use of a single-lumen tube with a blocker in patients with difficult airways to reduce the incidence of airway injury and fibrinoscopy at all stages of the perioperative period to guide airway management. This case study is the first report of the anesthetic management of a large, isolated fibrous tumor compressing the tracheal membrane in the upper esophagus.

CONCLUSION

This rare case emphasizes the importance of perioperative management of anesthesia in patients with large isolated fibrous tumors of the upper esophagus that compress the tracheal membrane. The use of blocker reduce the incidence of airway injury and fibrinoscopy at the perioperative period to guide airway management.

Clinical application of intubation-free anesthesia in radical resection of lung cancer

Background

In recent years, video-assisted thoracic surgery (VATS) has become increasingly widespread. However, the implementation of VATS requires the assistance with lung isolation techniques. Spontaneous breathing with laryngeal masks is also increasingly used in VATS. However, evidence on the characteristics of intubated anesthesia is insufficient.

Objective

This study aimed to explore whether intubation-free anesthesia has more advantages than other intubation methods in the clinical setting.

Methods

Patients with lung tumors who underwent VATS in our hospital between June 2022 and October 2022 were included in the study. Perioperative data of patients, including basic information, intraoperative hemodynamic changes, postoperative inflammatory indicators, and adverse reactions were obtained through the electronic medical record system. According to the protocol of airway management during anesthesia, participants were divided into the following groups: laryngeal mask with spontaneous breathing group (LMSB group), laryngeal mask combined with bronchial blocker group (LM + BB group), double-lumen tube group (DLT group), and tracheal tube combined with bronchial blocker group (TT + BB group). All data were analyzed using SPSS 25.0 software.

Results

At baseline, patients in the LMSB and LM + BB groups had a lower body weight (P = 0.024). Systolic blood pressure (SBP), diastolic BP (DBP), and heart rate (HR) were significantly higher in the DLT group than in the non-intubated group during surgery (SBP: T1 P = 0.048, T4 P = 0.021, T5 P ≤ 0.001, T6 P ≤ 0.001, T7 P = 0.004; DBP: T5 P ≤ 0.001, T6 P ≤ 0.001, T7 P ≤ 0.001; HR: T1 P = 0.021, T6 P ≤ 0.001, T7 P = 0.007, T8 P ≤ 0.001). The input fluid (P = 0.009), urine output (P = 0.010), surgery duration (P = 0.035), and procalcitonin levels (P = 0.024) of the DLT group were also significantly higher than those of the other groups. The recovery duration of the LMSB group was significantly longer (P = 0.003) and the incidence of postoperative adverse reactions, mainly atelectasis, was higher (P = 0.012) than those of the other groups.

Conclusion

Although the intubation-free anesthesia has less stimulation during operation and less postoperative inflammatory response, it has obvious adverse reactions after operation, which may be not the best anesthesia scheme for radical resection of lung cancer in VATS.

Clinical trial registration

https://www.chictr.org.cn/showproj.html?proj=182767, identifier ChiCTR2200066180.

Robot-assisted tumorectomy for an unusual pelvic retroperitoneal leiomyoma: A case report

RATIONALE

Extrauterine leiomyoma occasionally occurs in rare locations with unusual growth patterns, especially pelvic retroperitoneal leiomyoma, which brings great challenges for surgeons to make a diagnosis. It is essential to distinguish benign from malignant retroperitoneal neoplasms according to the imaging manifestations. Laparotomy and laparoscopy are the common options for pelvic retroperitoneal neoplasms, while they may cause side effects during operation such as secondary damage. Appropriate surgical techniques should be adopted to ensure the complete excision of neoplasms meanwhile preserve the urination, defecation, and sexual function.

PATIENT CONCERNS

A 30-year-old woman was referred to our hospital because of dull pain in the perianal region for 1 month. Laboratory results including tumor markers were all within normal limits. The digital rectal examination revealed a huge and tough mass with smooth mucosa protruding into the rectal cavity from the rear area of rectum.

DIAGNOSIS

Imaging examinations were performed. Contrasted computed tomography (CT) of pelvis showed an enhanced retroperitoneal solid mass in the space between sacrum and rectum, and very close to the levator ani muscle. The mass was about 11.0*8.0 cm in size. Computerized tomography angiography (CTA) showed the distal branches of bilateral internal iliac artery went into the mass. Endoscopic ultrasonography (US) showed the mass compressed the rectum, as well as a clear boundary to the rectal wall. A histopathologic examination confirmed the mass was a pelvic retroperitoneal leiomyoma.

INTERVENTIONS

The patient underwent an operative resection with da Vinci Si surgical system after routine preoperative preparation. Anorectal motility was weekly monitored postoperation. No additional adjuvant therapy was performed.

OUTCOMES

The patient could walk after 1 day and defecate normally on the third day after operation. She was discharged on the seventh postoperative day. No adverse events including pelvic floor hernia or defecation dysfunction occurred in the follow-up period. At 4 weeks follow-up, the patient was pain-free and recovered well.

LESSONS

Although imaging examinations were crucial for retroperitoneal neoplasms, histopathological examination remains the "gold standard" for making a definite diagnosis. This case highlights the possibility of retroperitoneal leiomyoma occurring in a woman of reproductive age and the advantages of robotic surgical system in pelvic retroperitoneal surgeries.