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Assessment of the Operative Feasibility and Ventilation Distribution during Nonintubation Thoracoscopic Surgery Using Electrical Impedance Tomography. J Pers Med 2022; 12:jpm12071066. [PMID: 35887563 PMCID: PMC9318683 DOI: 10.3390/jpm12071066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background: To investigate the feasibility, ventilation distribution, and physiological effect of iatrogenic pneumothorax generated during nonintubated thoracoscopic surgery using electrical impedance tomography. Methods: Patients who underwent resections for pulmonary nodules between April 2016 and April 2019 were enrolled prospectively. Electrical impedance tomography was performed, and the measurements were recorded at five different timepoints. The patient characteristics, pathological characteristics, surgical procedures, operation times, and intraoperative parameters were recorded and analyzed. Results: Two hundred sixty-five perioperative electrical impedance tomography measurements during nonintubated thoracoscopic surgery were recorded in fifty-three patients. Fifty-one patients underwent wedge resections, and two patients underwent segmentectomies. The preoperative lateral decubitus position time point showed greater ventilation in the right lung than in the left lung. For left-sided surgery, the nonoperative lung had better ventilation (64.5% ± 14.1% for the right side vs. 35.5% ± 14.1% for the left side, p < 0.0001). For right-sided surgery, the nonoperative lung did not have better ventilation (52.4% ± 16.1% for the right side vs. 47.6% ± 16.1% for the left side, p = 0.44). The center of ventilation was significantly increased after surgery (p < 0.001). The global index of ventilation showed no difference after surgery. Conclusions: The nonintubated thoracoscopic surgical side had different ventilation distributions but reached ventilation equilibrium after the operation. Electrical impedance tomography is feasible and safe for monitoring ventilation without adverse effects.
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Yao W, Li M, Zhang C, Luo A. Recent Advances in Videolaryngoscopy for One-Lung Ventilation in Thoracic Anesthesia: A Narrative Review. Front Med (Lausanne) 2022; 9:822646. [PMID: 35770016 PMCID: PMC9235869 DOI: 10.3389/fmed.2022.822646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
Since their advent, videolaryngoscopes have played an important role in various types of airway management. Lung isolation techniques are often required for thoracic surgery to achieve one-lung ventilation with a double-lumen tube (DLT) or bronchial blocker (BB). In the case of difficult airways, one-lung ventilation is extremely challenging. The purpose of this review is to identify the roles of videolaryngoscopes in thoracic airway management, including normal and difficult airways. Extensive literature related to videolaryngoscopy and one-lung ventilation was analyzed. We summarized videolaryngoscope-guided DLT intubation techniques and discussed the roles of videolaryngoscopy in DLT intubation in normal airways by comparison with direct laryngoscopy. The different types of videolaryngoscopes for DLT intubation are also compared. In addition, we highlighted several strategies to achieve one-lung ventilation in difficult airways using videolaryngoscopes. A non-channeled or channeled videolaryngoscope is suitable for DLT intubation. It can improve glottis exposure and increase the success rate at the first attempt, but it has no advantage in saving intubation time and increases the incidence of DLT mispositioning. Thus, it is not considered as the first choice for patients with anticipated normal airways. Current evidence did not indicate the superiority of any videolaryngoscope to another for DLT intubation. The choice of videolaryngoscope is based on individual experience, preference, and availability. For patients with difficult airways, videolaryngoscope-guided DLT intubation is a primary and effective method. In case of failure, videolaryngoscope-guided single-lumen tube (SLT) intubation can often be achieved or combined with the aid of fibreoptic bronchoscopy. Placement of a DLT over an airway exchange catheter, inserting a BB via an SLT, or capnothorax can be selected for lung isolation.
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Ramcharran H, Wallen J. Robotic-assisted thoracoscopic resection of anterior mediastinal cystic teratoma: a case report and literature review. J Cardiothorac Surg 2022; 17:67. [PMID: 35382841 PMCID: PMC8985258 DOI: 10.1186/s13019-022-01806-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 03/18/2022] [Indexed: 11/15/2022] Open
Abstract
Background Mediastinal teratomas are rare tumors that frequently occur in the anterior mediastinum. The majority of these tumors are benign and slow growing. Due to their low malignant potential, the treatment for these tumors is surgical resection. More recently, the surgical management has shifted from invasive approaches such as a sternotomy to minimally invasive ones such as robotic-assisted thoracoscopic resections utilizing lung isolation ventilation. We present a rare case of a locally advanced mediastinal teratoma requiring resection, which was initially attempted thoracoscopically using double lung ventilation. Case presentation A 43 year-old female was found to have an anterior mediastinal mass during work-up for an intermittent cough in 2009. Chest imaging and biopsy at the time showed evidence of a cystic teratoma without concerning features. She underwent imaging surveillance until 2018, when repeat chest imaging showed increasing growth and worrisome radiologic features concerning for malignant degeneration. She underwent an elective robotic-assisted thoracoscopic resection utilizing double lung ventilation, but due to extensive involvement of the right lung, pericardium, superior vena cava, and right phrenic nerve the patient had to be repositioned and started on single lung ventilation mid-procedure to facilitate a safe and complete resection. Conclusions Anterior mediastinal teratomas can be successfully removed by robotic-assisted thoracoscopic resections utilizing single lung ventilation. Though robotic-assisted thoracoscopic resection utilizing double lung ventilation can be effective in performing certain procedures such as lung wedge resections, thymectomy, pleural biopsies and minimally invasive cardiac procedures, it is limited in removing locally advanced mediastinal tumors.
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Affiliation(s)
- Harry Ramcharran
- Department of Thoracic Surgery, SUNY Upstate Medial University, 750 East Adams Street, Syracuse, NY, 13210, USA.
| | - Jason Wallen
- Department of Thoracic Surgery, SUNY Upstate Medial University, 750 East Adams Street, Syracuse, NY, 13210, USA
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Chuang KH, Lai HH, Chen Y, Chen LC, Lu HI, Chen YH, Li SH, Lo CM. Improvement of surgical complications using single-lumen endotracheal tube intubation and artificial carbon dioxide pneumothorax in esophagectomy: a meta-analysis. J Cardiothorac Surg 2021; 16:100. [PMID: 33882958 PMCID: PMC8059030 DOI: 10.1186/s13019-021-01459-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 04/05/2021] [Indexed: 12/29/2022] Open
Abstract
Background Esophageal cancer has a poor prognosis. Surgery is the main treatment but involves a high risk of complications. Some surgical strategies have tried to eliminate complications. Our meta-analysis tried to find the benefits of single-lumen endotracheal tube intubation with carbon dioxide (CO2) inflation. Methods A systematic search of studies on esophagectomy and CO2 inflation was conducted using PubMed, Medline, and Scopus. The odds ratio of post-operative pulmonary complications and anastomosis leakage were the primary outcomes. The standardized mean difference (SMD) in post-operative hospitalization duration was the secondary outcome. Results The meta-analysis included four case-control studies with a total of 1503 patients. The analysis showed a lower odds ratio of pulmonary complications in the single-lumen endotracheal tube intubation in the CO2 inflation group (odds ratio: 0.756 [95% confidence interval, CI: 0.518 to 1.103]) compared to that in the double-lumen endotracheal tube intubation group, but anastomosis leakage did not improve (odds ratio: 1.056 [95% CI: 0.769 to 1.45])). The SMD in hospitalization duration did not show significant improvement. (SMD: -0.141[95% CI: − 0.248 to − 0.034]). Conclusions Single-lumen endotracheal tube intubation with CO2 inflation improved pulmonary complications and shortened the hospitalization duration. However, no benefit in anastomosis leakage was observed.
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Affiliation(s)
- Kai-Hao Chuang
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niaosung Dist., Kaohsiung, Taiwan, Republic of China
| | - Hsing-Hua Lai
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niaosung Dist., Kaohsiung, Taiwan, Republic of China
| | - Yu Chen
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niaosung Dist., Kaohsiung, Taiwan, Republic of China
| | - Li-Chun Chen
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niaosung Dist., Kaohsiung, Taiwan, Republic of China
| | - Hung-I Lu
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niaosung Dist., Kaohsiung, Taiwan, Republic of China
| | - Yen-Hao Chen
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shau-Hsuan Li
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Ming Lo
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niaosung Dist., Kaohsiung, Taiwan, Republic of China.
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Pham LH, Trinh DK, Nguyen AV, Nguyen LS, Le DT, Nguyen DH, Doan HQ, Nguyen UH. Thoracoscopic surgery approach to mediastinal mature teratomas: a single-center experience. J Cardiothorac Surg 2020; 15:35. [PMID: 32051013 PMCID: PMC7017456 DOI: 10.1186/s13019-020-1076-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 01/30/2020] [Indexed: 11/26/2022] Open
Abstract
Background Mediastinal mature teratomas are rare tumors with diverse surgical approaches. The aim of this study is to review our experience of thoracoscopic surgery management in patients with teratomas. Methods We retrospectively reviewed 28 consecutive patients with mediastinal mature teratomas who underwent thoracoscopic surgery at Viet Duc University Hospital from January 2008 to August2018. Patients were divided into 2 groups with 2 types of thoracoscopic surgery, closed thoracoscopic surgery (CTS) group and video-assisted thoracoscopic surgery (VATS) group. The selection of sugical approach was based on sizes, locations and characteristics of tumors. Post-operative outcomes were assessed and compared between these 2 groups. Results There were 14 female and 14 male patients with a median age of 41.2 ± 13.8 years. A total of 22 teratomas were located on the right side of the chest cavity and 6 on the left side. We performed CTS in 21 patients (75%) and VATS in 7 patients (25%) for tumor resection. There were 3 cases (10.7%) required conversion to minithoracotomy (5 cm in incision length). Skin appendages accounted for the highest rate (96.4%) in pathology. There was no record of mortality or tumor recurrence detected by computerized tomography. Conclusion A thoracoscopic surgery for a mediastinal mature teratoma was a feasible choice. Challenging factors such as large tumors, intraoperative bleeding and strong tumor cell adhesion were considered handling by conversion to mini-thoracotomy that could ensure safety procedures and complete removal of tumors. Extraction of tumor contents might be performed for patients with large mature cystic teratomas to facilitate thoracoscopic surgery.
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Affiliation(s)
- Lu Huu Pham
- Cardiovascular and Thoracic Center, Viet Duc University Hospital, Hanoi, 100000, Vietnam.,Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Diep Ke Trinh
- Department of Anesthesia, Viet Duc University Hospital, Hanoi, 100000, Vietnam
| | - Anh Viet Nguyen
- Cardiovascular and Thoracic Center, Viet Duc University Hospital, Hanoi, 100000, Vietnam
| | - Lanh Sy Nguyen
- Department of Pathology, Viet Duc University Hospital, Hanoi, 100000, Vietnam
| | - Dung Thanh Le
- Department of Radiology, Viet Duc University Hospital, Hanoi, 100000, Vietnam
| | - Dinh-Hoa Nguyen
- Department of Trauma and Orthopaedic Surgery, Viet Duc University Hospital, Hanoi, 100000, Vietnam.
| | - Hung Quoc Doan
- Cardiovascular and Thoracic Center, Viet Duc University Hospital, Hanoi, 100000, Vietnam.,Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Uoc Huu Nguyen
- Cardiovascular and Thoracic Center, Viet Duc University Hospital, Hanoi, 100000, Vietnam.,Hanoi Medical University, Hanoi, 100000, Vietnam
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Zhao M, Jiang T, Li M, Yang X, Dai X, Shen Y, Lin M, Feng M, Wang Q. Video-assisted thoracoscopic total thymectomy: two-lung ventilation with artificial pneumothorax. MINIM INVASIV THER 2019; 29:380-384. [PMID: 31691623 DOI: 10.1080/13645706.2019.1660681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Double-lumen endotracheal tube (DLET) and one-lung ventilation (OLV) have been generally accepted as the classic anesthetic method in video-assisted thoracoscopic total thymectomy (VATT). However, there are still some disadvantages of DLET. Two-lung ventilation (TLV) with single-lumen endotracheal tube (SLET) is considered to be an alternative in VATT to avoid these disadvantages. This study evaluated the safety and feasibility of TLV in VATT by comparing it with OLV cases.Material and methods: We retrospectively screened 198 patients who received TLV unilateral thoracic incision VATT and 117 patients who received OLV unilateral thoracic incision VATT. Perioperative data were analyzed, including surgical variables, intraoperative hemodynamic parameters, and postoperative complications and hospital stay.Results: No significant differences with regard to operative time (p = .146), postoperative hospital stay (p = .553), complications (p = .254), hemodynamic parameters and pulse oxygen saturation (SpO2) were found between TLV group and OLV group. However, end-tidal CO2 (EtCO2) was higher in TLV group at 15 min (39.95 ± 5.03 vs 38.70 ± 4.57, p = .021) and 30 min (41.91 ± 5.50 vs 38.91 ± 4.51, p < .001) after initiation of the operation.Conclusions: It is safe and feasible to adopt TLV using SLET with CO2 insufflation artificial pneumothorax in unilateral thoracic incision VATT.
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Affiliation(s)
- Mengnan Zhao
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Tian Jiang
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Ming Li
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China.,Eight-Year Program Clinical Medicine, Grade of 2014, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xinyu Yang
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China.,Eight-Year Program Clinical Medicine, Grade of 2014, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiyu Dai
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China.,Eight-Year Program Clinical Medicine, Grade of 2014, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yaxing Shen
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Miao Lin
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Mingxiang Feng
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
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Lin M, Shen Y, Feng M, Tan L. Is two lung ventilation with artificial pneumothorax a better choice than one lung ventilation in minimally invasive esophagectomy? J Thorac Dis 2019; 11:S707-S712. [PMID: 31080648 DOI: 10.21037/jtd.2018.12.08] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Two lung ventilation (TLV) with artificial pneumothorax has been introduced into MIE for several years. A few researches have reported its clinical application, and proved its safety and feasibility. However, it is still controversial whether TLV with artificial pneumothorax is a better choice than one lung ventilation (OLV). Obviously, single lumen endotracheal tube is easy for intubation and intraoperative maintenance. Potential problems during intervention include hemodynamic changes, oxygenation, and air embolism. In this paper, present literature is reviewed about two and one lung ventilation in thoracoscopy, looking for clear conclusions for future application.
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Affiliation(s)
- Miao Lin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yaxing Shen
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Mingxiang Feng
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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8
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Single lumen endotracheal intubation with carbon dioxide insufflation for lung isolation in thoracic surgery. Surg Endosc 2018; 33:3287-3290. [PMID: 30511311 DOI: 10.1007/s00464-018-06614-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 11/23/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Double lumen tube (DLT) intubation is used for lung isolation but is not without disadvantages including increased intubation time, anesthesia expertise, risk of airway trauma, and costs over single lumen tube (SLT) intubation. SLT intubation with CO2 insufflation can be used as an alternative for lung isolation. We reviewed our experience with this technique during thoracoscopic surgery. METHODS We performed a retrospective review of a prospectively maintained IRB-approved database from 2009 to 2018. Operations were performed with CO2 insufflation up to 15 mmHg. Indications for surgery, operative details, intraoperative complications, pathology, and postoperative complications were reviewed. RESULTS We identified 123 patients (70 females [57%]) with a median age of 40 years (range 16-80 years) and a median BMI of 26.2 kg/m2 (range 15-59 kg/m2) that underwent minimally invasive thoracoscopic procedures with this technique. Procedures included: mediastinal mass resection or biopsy (41%), sympathectomy (37%), wedge resection (10%), first rib resection (6%), diaphragm plication (2%), segmentectomy (2%), decortication (2%), pleural biopsy (2%), and pericardial cyst resection (1%). Median operative time was 90 min (range 25-584 min) and median intraoperative blood loss was 10 mL (range 2-200 mL). Intraoperative hemodynamic parameters were obtained at procedure start, 1 h after CO2 insufflation, and at procedure completion: we observed significant changes in heart rate and systolic blood pressure (P = 0.027 and P < 0.001, respectively) although clinically inconsequential. Mean end-tidal CO2 1 h after insufflation was 36.6 ± 4.5 mmHg. There were no intraoperative complications and no conversions to a DLT. Median length of stay was 1 day (range 0-14 days). Five complications (4%) were observed and no mortalities. CONCLUSIONS SLT intubation and CO2 insufflation is a feasible and safe alternative to DLT intubation for lung isolation. This can be a useful strategy to accomplish lung isolation for some thoracoscopic procedures, in particular when expertise for DLT placement is unavailable.
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Lin M, Shen Y, Wang H, Fang Y, Qian C, Xu S, Ge D, Feng M, Tan L, Wang Q. A comparison between two lung ventilation with CO 2 artificial pneumothorax and one lung ventilation during thoracic phase of minimally invasive esophagectomy. J Thorac Dis 2018; 10:1912-1918. [PMID: 29707346 DOI: 10.21037/jtd.2018.01.150] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background To investigate the feasibility and safety of two lung ventilation with artificial pneumothorax in minimally invasive esophagectomy (MIE) through a comparison with conventional one lung ventilation. Methods Eleven hundred and sixty-six patients with esophageal cancer, who underwent McKeown MIE in our center from February 2006 to December 2016, were studied retrospectively. Seven hundred and five patients who underwent one lung ventilation with double lumen endotracheal tube (DLET) were assigned to DLET group. Other 461 patients who underwent two lung ventilation with single lumen endotracheal tube (SLET) were assigned to SLET group. Clinical characteristics, surgical variables and complications were compared between two groups. Results There were comparable patient characteristics in two groups. Surgical variables and complications were discussed between two groups. SLET group seemed to have shorter operative time, shorter postoperative hospital stay, and more harvested recurrent laryngeal nerve (RLN) lymph nodes than DLET group, which might be attributed to experienced surgeons. However, there were no significant differences of complications between two groups. Intraoperative clinical parameters were further studied. Before intubation and artificial pneumothorax, there were no significant differences between two groups, except diastolic blood pressure (DBP). With the application of artificial pneumothorax, patients in SLET group have obviously higher PO2, PCO2, and PetCO2 value, and slightly lower pH value and blood pressure during thoracic phase. After the thoracic phase, the changes induced by artificial pneumothorax in SLET group were gradually reversed and clinical parameters gradually return to normal level. Conclusions Two lung ventilation with artificial pneumothorax is a safe and feasible choice during MIE.
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Affiliation(s)
- Miao Lin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yaxing Shen
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hao Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yong Fang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Cheng Qian
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Songtao Xu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Di Ge
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Mingxiang Feng
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Fitzgerald DB, Koegelenberg CFN, Yasufuku K, Lee YCG. Surgical and non-surgical management of malignant pleural effusions. Expert Rev Respir Med 2017; 12:15-26. [PMID: 29111830 DOI: 10.1080/17476348.2018.1398085] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Optimal management of malignant pleural effusion (MPE) is important in the care of patients with advanced cancer. Surgical (especially video-assisted thoracoscopic surgery (VATS)) and non-surgical strategies are available. Clinicians should be aware of the evidence supporting the use of different modalities to guide treatment choice. Areas covered: This review covers published evidence of the advantages and disadvantages of VATS and non-surgical alternatives for MPE management. Expert commentary: Randomized clinical trials (RCTs) are needed to define the roles and benefits of VATS as existing literature is often flawed by selection bias. Three RCTs have failed to show benefits of VATS talc poudrage over bedside talc pleurodesis. VATS-pleurectomy offered no survival advantage in a RCT of mesothelioma patients. Modification of VATS techniques has reduced the invasiveness and associated risks. Future trials should compare VATS with contemporary, non-surgical approaches (especially combined Indwelling Pleural Catheter (IPC) and chemical pleurodesis therapy). Individualized management for different subgroups of MPE patients should be a long-term research goal. Studies are needed on better patient selection, and adjunct non-invasive, supportive (e.g. nutrition and exercise) therapies.
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Affiliation(s)
- Deirdre B Fitzgerald
- a School of Medicine & Pharmacology , University of Western Australia , Crawley , WA , Australia.,b Pleural Medical Unit , Institute for Respiratory Health , Nedlands , WA , Australia.,c Department of Respiratory Medicine , Sir Charles Gairdner Hospital , Nedlands , WA , Australia
| | - Coenraad F N Koegelenberg
- d Division of Pulmonology, Department of Medicine , Stellenbosch University and Tygerberg Academic Hospital , Cape Town , South Africa
| | - Kazuhiro Yasufuku
- e Division of Thoracic Surgery , Toronto General Hospital University Health Network, University of Toronto , Toronto , ON , Canada
| | - Y C Gary Lee
- a School of Medicine & Pharmacology , University of Western Australia , Crawley , WA , Australia.,b Pleural Medical Unit , Institute for Respiratory Health , Nedlands , WA , Australia.,c Department of Respiratory Medicine , Sir Charles Gairdner Hospital , Nedlands , WA , Australia
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11
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Han KN, Kim HK, Lee HJ, Lee DK, Kim H, Lim SH, Choi YH. Single-port thoracoscopic surgery for pneumothorax under two-lung ventilation with carbon dioxide insufflation. J Thorac Dis 2016; 8:1080-6. [PMID: 27293823 DOI: 10.21037/jtd.2016.03.95] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The development of single-port thoracoscopic surgery and two-lung ventilation reduced the invasiveness of minor thoracic surgery. This study aimed to evaluate the feasibility and safety of single-port thoracoscopic bleb resection for primary spontaneous pneumothorax using two-lung ventilation with carbon dioxide insufflation. METHODS Between February 2009 and May 2014, 130 patients underwent single-port thoracoscopic bleb resection under two-lung ventilation with carbon dioxide insufflation. Access was gained using a commercial multiple-access single port through a 2.5-cm incision; carbon dioxide gas was insufflated through a port channel. A 5-mm thoracoscope, articulating endoscopic devices, and flexible endoscopic staplers were introduced through a multiple-access single port for bulla resection. RESULTS The mean time from endotracheal intubation to incision was 29.2±7.8 minutes, the mean operative time was 30.9±8.2 minutes, and the mean total anesthetic time was 75.5±14.4 minutes. There were no anesthesia-related complications or wound problems. The chest drain was removed after a mean of 3.7±1.4 days and patients were discharged without complications 4.8±1.5 days from the operative day. During a mean 7.5±10.1 months of follow-up, there were five recurrences (3.8%) in operated thorax. CONCLUSIONS The anesthetic strategy of single-lumen intubation with carbon dioxide gas insufflation can be a safe and feasible option for single-port thoracoscopic bulla resection as it represents the least invasive surgical option with the potential advantages of reducing operative time and one-lung ventilation-related complications without diminishing surgical outcomes.
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Affiliation(s)
- Kook Nam Han
- 1 Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea ; 2 Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyun Koo Kim
- 1 Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea ; 2 Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyun Joo Lee
- 1 Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea ; 2 Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Dong Kyu Lee
- 1 Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea ; 2 Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Heezoo Kim
- 1 Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea ; 2 Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sang Ho Lim
- 1 Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea ; 2 Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young Ho Choi
- 1 Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea ; 2 Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Republic of Korea
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Zhang M, Wang H, Pan X, Wu W, Zhang H. Thoracoscopic resection of bulky thymoma assisted with artificial pneumothorax: A report of 19 consecutive cases. Oncol Lett 2016; 11:3061-3063. [PMID: 27123063 PMCID: PMC4841113 DOI: 10.3892/ol.2016.4326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/10/2016] [Indexed: 11/24/2022] Open
Abstract
The aim of the present study was to examine the feasibility and efficacy of thoracoscopic radical resection of large retrosternal thymoma using artificial pneumothorax. A retrospective analysis was performed on 19 patients with bulky thymoma who underwent thoracoscopic resection using artificial pneumothorax by CO2 insufflation. The operations were performed with unilateral or bilateral thoracic incisions via single lumen endotracheal intubation and two-lung ventilation. This approach provided excellent exposure of the thoracic cavity and reliable control of the neuro-vascular structures in the anterior mediastinum, which was of vital importance for the extended resection of malignant thymoma. The operation time was 140.0±51.4 min without conversion to thoracotomy or sternotomy. The pathological diagnosis was confirmed by immunohistochemistry, including 5 cases of thymus lipomyoma, 1 case of thymus hyperplasia, 1 case of thymus cyst, 2 cases of type AB thymoma, 4 cases of type B1 thymoma, 4 cases of type B3 thymoma, and 2 cases of thymic carcinoma. Furthermore, there were no complications such as recurrent laryngeal nerve injury, phrenic nerve injury, pulmonary infection or atelectasis, with a hospital stay of 5.0±3.0 days. In conclusion, the thoracoscopic resection of thymoma using artificial pneumothorax is a preferable approach, that may be considered for patients with bulky retrosternal tumors.
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Affiliation(s)
- Miao Zhang
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou, Jiangsu 221009, P.R. China
| | - Heng Wang
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou, Jiangsu 221009, P.R. China
| | - Xuefeng Pan
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou, Jiangsu 221009, P.R. China
| | - Wenbin Wu
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou, Jiangsu 221009, P.R. China
| | - Hui Zhang
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou, Jiangsu 221009, P.R. China
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Abstract
The paradigm for postoperative care for thoracic surgical patients in the United States has shifted with efforts to reduce hospital length of stay and improve quality of life. The increasing usage of minimally invasive techniques in thoracic surgery has been an important part of this. In this review we will examine our standard practices as well as the evidence behind both general contemporary postoperative care principles and those specific to certain operations.
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Affiliation(s)
- Benjamin Wei
- Division of Cardiothoracic Surgery, University of Alabama-Birmingham Medical Center, Birmingham, AL, USA
| | - Robert J Cerfolio
- Division of Cardiothoracic Surgery, University of Alabama-Birmingham Medical Center, Birmingham, AL, USA
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Shojaee S, Lee HJ. Thoracoscopy: medical versus surgical-in the management of pleural diseases. J Thorac Dis 2016; 7:S339-51. [PMID: 26807282 DOI: 10.3978/j.issn.2072-1439.2015.11.66] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Diseases of the pleura continue to affect a large population of patients worldwide and in the United States. Pleural fluid analysis and accompanying imaging of the pleura including chest X-rays, chest computed tomography (CT) scan and chest ultrasonography are among the first steps in the management of pleural effusions. When further diagnostic or therapeutic work up is necessary, open thoracotomy and thoracoscopy come to mind. However, given the significant morbidity and mortality associated with open thoracotomy, and the advances in medicine and medical instruments, thoracoscopy has now become a routine procedure in the management of the disease of the chest including pleura. Debates about surgical vs. medical thoracoscopy (MT) are ongoing. In the following pages we review the literature and discuss the similarities and differences between the two procedures, as well as their indications, contraindications, complications and efficacy in the management of pleural diseases.
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Affiliation(s)
- Samira Shojaee
- 1 Virginia Commonwealth University, Richmond, VA 23219, USA ; 2 Johns Hopkins Hospital, Baltimore, MD 21287, USA
| | - Hans J Lee
- 1 Virginia Commonwealth University, Richmond, VA 23219, USA ; 2 Johns Hopkins Hospital, Baltimore, MD 21287, USA
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15
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Lee DK, Kim HK, Lee K, Choi YH, Lim SH, Kim H. Optimal Respiratory Rate for Low-Tidal Volume and Two-Lung Ventilation in Thoracoscopic Bleb Resection. J Cardiothorac Vasc Anesth 2014; 29:972-6. [PMID: 25440636 DOI: 10.1053/j.jvca.2014.06.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVES One-lung ventilation is considered to be mandatory in video-assisted thoracoscopic surgery. However, the authors showed in a previous report that two-lung ventilation with low tidal volume is feasible in thoracoscopic bleb resection (TBR). In this study, they evaluated optimal respiratory rate during TBR under two-lung ventilation with low-tidal volume anesthesia. DESIGN A prospective, randomized, single-blinded intervention study. SETTING An operating room in a teaching hospital. PARTICIPANTS Forty-eight patients who underwent scheduled TBR under general anesthesia. INTERVENTIONS TBR was performed under low-tidal-volume (5 mL/kg), two-lung ventilation. Respiratory rate (RR) varied according to the protocol: 15 (group I), 18 (group II), and 22 cycles/min (group III). Using block randomization method, 16 patients were assigned to each of 3 groups. MEASUREMENTS AND MAIN RESULTS Minute ventilation of group I was lowered significantly compared with the other groups (p<0.001). The results of arterial blood gas analysis were in the physiologic range in all patients. Surgery and anesthetic times and number of endostaples used were not significantly different among the 3 groups. CONCLUSIONS The RR of 15 cycles/min with low-tidal volume (5 mL/kg) and two-lung ventilation did not produce abnormal physiologic changes including arterial pH, partial arterial oxygen pressure, and partial pressure of carbon dioxide and guaranteed an optimal surgical field. Therefore, these setting are considered acceptable for two-lung ventilation during TBR.
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Affiliation(s)
- Dong Kyu Lee
- Departments of *Anesthesiolafogy and Pain Medicine
| | - Hyun Koo Kim
- Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kanghoon Lee
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young Ho Choi
- Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sang Ho Lim
- Departments of *Anesthesiolafogy and Pain Medicine
| | - Heezoo Kim
- Departments of *Anesthesiolafogy and Pain Medicine.
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16
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Zhang R, Liu S, Sun H, Liu X, Wang Z, Qin J, Hua X, Li Y. The application of single-lumen endotracheal tube anaesthesia with artificial pneumothorax in thoracolaparoscopic oesophagectomy. Interact Cardiovasc Thorac Surg 2014; 19:308-10. [PMID: 24740912 DOI: 10.1093/icvts/ivu100] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Double-lumen endotracheal tube (DLET) anaesthesia is the commonly used method in minimally invasive oesophagectomy (MIE). However, DLET intubation does have its disadvantages. Firstly, the placement of the DLET needs a skilled anaesthetist with familiarity of the technique and subsequent ability to perform a fibre-optic bronchoscopy for confirmation. Secondly, DLET intubation and one-lung ventilation are associated with numerous complications, including hoarseness, tracheobronchial injury and vocal injury. In this report, a retrospective analysis was performed on 42 consecutive patients who underwent MIE using single-lumen endotracheal tube (SLET) anaesthesia with CO2 artificial pneumothorax compared with 81 patients who underwent the same procedure with DLET intubation. Our findings showed that SLET intubation with artificial pneumothorax by CO2 insufflation is a feasible and safe method for MIE procedures.
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Affiliation(s)
- Ruixiang Zhang
- Department of Thoracic Surgery, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Shilei Liu
- Department of Thoracic Surgery, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Haibo Sun
- Department of Thoracic Surgery, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Xianben Liu
- Department of Thoracic Surgery, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Zongfei Wang
- Department of Thoracic Surgery, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianjun Qin
- Department of Thoracic Surgery, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Xionghuai Hua
- Department of Thoracic Surgery, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Yin Li
- Department of Thoracic Surgery, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
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Sancheti MS, Dewan BP, Pickens A, Fernandez FG, Miller DL, Force SD. Thoracoscopy Without Lung Isolation Utilizing Single Lumen Endotracheal Tube Intubation and Carbon Dioxide Insufflation. Ann Thorac Surg 2013; 96:439-44. [DOI: 10.1016/j.athoracsur.2013.04.060] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 04/15/2013] [Accepted: 04/22/2013] [Indexed: 11/15/2022]
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18
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Eldaboosy SAM, El-shamly M, Halima KM, Shaarawy AT, Alwakil I, Osama M. Medical video assisted thoracoscopy – minimally invasive diagnostic tool for diagnosis of undiagnosed pleural effusion. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2013. [DOI: 10.1016/j.ejcdt.2013.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Toolabi K, Aminian A, Javid MJ, Mirsharifi R, Rabani A. Minimal access mediastinal surgery: One or two lung ventilation? J Minim Access Surg 2011; 5:103-7. [PMID: 20407569 PMCID: PMC2843124 DOI: 10.4103/0972-9941.59308] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Accepted: 11/04/2009] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND: Minimal access mediastinal surgery (MAMS) is usually performed under general anaesthesia with double lumen tubes (DLT). The aim of this study is to evaluate two lung ventilation through single lumen tubes (SLT) during thoracoscopic sympathectomy for hyperhidrosis and thoracoscopic thymectomy for myasthenia gravis. METHODS: In this prospective non-randomized study, MAMS was performed in 58 patients with hyperhidrosis and 42 patients with myasthenia gravis, from January 2002 to December 2008. Patients were intubated with a DLT or SLT, 50 patients in each group. In the DLT group, endobronchial tubes were placed using the traditional blind approach and one lung ventilation was confirmed clinically. In the SLT group, the hemithorax was insufflated with CO2 in conjunction with two-lung anaesthesia. All the patients were evaluated for haemodynamic stability, oxygen saturation of haemoglobin (Spo2), end-tidal Pco2 (ETPco2), times required for intubation and surgery, satisfaction of surgeon with regard to exposure and postoperative complications. RESULTS: In the SLT group, all the patients had stable haemodynamic and ventilation parameters. In the DLT group, haemodynamic instability occurred in two, decrease in Spo2 in four and increase in ETPco2 in three patients. One patient in the DLT group developed vocal cord granuloma two months later. Time required for surgery and the surgeon's opinion with regard to exposure were similar for both groups. CONCLUSION: Thoracoscopic surgery when used in cases where a well-collapsed lung may not be essential, since surgery is not performed on the lung itself, does not require DLT. SLT is safe in MAMS. It provides good surgical exposure and decreases the cost, time and undesirable complications of DLT.
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Affiliation(s)
- Karamollah Toolabi
- Department of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
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20
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Cheng YL, Huang TW, Lee SC, Wu CT, Chen JC, Chang H, Tzao C. Video-assisted thoracoscopic surgery using single-lumen endotracheal tube anaesthesia in primary spontaneous pneumothorax. Respirology 2010; 15:855-9. [PMID: 20653920 DOI: 10.1111/j.1440-1843.2010.01801.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Primary spontaneous pneumothorax (PSP) is a common condition that typically affects young adults. With recent advances in techniques, VATS is now a safe and accepted procedure for treating PSP. Lung isolation techniques have been commonly used to facilitate surgical procedures in the past. The purpose of this study was to evaluate the feasibility of using a single-lumen endotracheal tube for thoracoscopic surgery in patients with PSP. METHODS A series of 121 consecutive patients with PSP, who underwent VATS using a double-lumen or single-lumen endotracheal tube between January 2000 and December 2002, were assessed retrospectively. The clinical features, operation times, complications, hospital stays and recurrences of PSP in these patients were recorded and analysed. RESULTS There were no significant differences in gender, BMI, smoking habits, blebs/bullae on CT, duration of surgery or recurrence of PSP between the two groups. Patients in the single-lumen endotracheal tube group had a shorter duration of anaesthesia (15.4 +/- 2.6 vs 25.6 +/- 3.2 min, P < 0.001), lower early complication rates, lower costs and shorter hospital stays (3.6 +/- 3.0 vs 4.5 +/- 2.8 days, P = 0.02) compared with those in the double-lumen endotracheal tube group. The follow-up period was 40-68 months (mean 54 months). There were two recurrences in each group (3.1% vs 3.4%). CONCLUSIONS VATS for the treatment of PSP was easily performed using a single-lumen endotracheal tube, and resulted in lower intubation-related costs, fewer complications and equivalent outcomes, compared with procedures performed using double-lumen endotracheal tube anaesthesia.
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Affiliation(s)
- Yeung-Leung Cheng
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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21
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Kim H, Kim HK, Choi YH, Lim SH. Thoracoscopic bleb resection using two-lung ventilation anesthesia with low tidal volume for primary spontaneous pneumothorax. Ann Thorac Surg 2009; 87:880-5. [PMID: 19231412 DOI: 10.1016/j.athoracsur.2008.12.071] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Revised: 12/22/2008] [Accepted: 12/22/2008] [Indexed: 01/08/2023]
Abstract
BACKGROUND We performed thoracoscopic surgery for pneumothorax using two-lung ventilation with low tidal volume and evaluated the feasibility and safety of this procedure. METHODS Forty-six patients (mean age, 23.6 +/- 10.47 years) each with a primary spontaneous pneumothorax underwent wedge resection with chemical and mechanical pleurodesis. Two-lung ventilation anesthesia was performed with a single-lumen endotracheal tube, and the tidal volume was reduced to 4 mL/kg; the respiratory rate was increased to 24 cycles/min. Airway pressure, end-tidal CO(2), and the results of blood gas analysis were obtained right after endotracheal intubation and during the operation, and were compared. RESULTS The tidal volume was 496.2 +/- 94.33 mL at anesthesia induction, which decreased to 243.9 +/- 34.43 mL during the two-lung ventilation. In 5 patients, the tidal volume was additionally decreased by 32.5 +/- 12.58 mL (p = 0.014) to obtain an optimal working field. The differences between the airway pressure, pH, partial pressure of carbon dioxide, and partial pressure of oxygen were significant between the two measurement times. However, all of the values of the arterial blood gas analysis were within normal range. The oxygen saturation (99.9% +/- 0.69% versus 99.8 +/- 0.72%; p = 0.160) and end-tidal CO(2) (33.2 +/- 3.74 mm Hg versus 34.1 +/- 4.19 mm Hg; p = 0.157) were not significantly different. The time from intubation before the incision was 17.1 +/- 4.18 minutes, the operation time was 31.9 +/- 14.48 minutes, and the total anesthesia time was 65.8 +/- 15.02 minutes. CONCLUSIONS Thoracoscopic surgery for primary spontaneous pneumothorax using two-lung ventilation with low tidal volume was technically feasible.
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Affiliation(s)
- Heezoo Kim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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22
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Lytle FT, Brown DR. Appropriate Ventilatory Settings for Thoracic Surgery: Intraoperative and Postoperative. Semin Cardiothorac Vasc Anesth 2008; 12:97-108. [DOI: 10.1177/1089253208319869] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Mechanical ventilation of patients undergoing thoracic surgery is often challenging. These patients frequently have significant underlying comorbidities, including cardiopulmonary disease, and often must undergo 1-lung ventilation. Perioperative respiratory complications are common and are multifactorial in etiology. Increasing evidence suggests that mechanical ventilation is associated with, and may even cause, lung damage in both sick and healthy patients. Gas exchange to provide acceptable end-organ oxygenation remains a primary goal but so too is minimization of risks for acute lung injury. Every ventilator strategy is associated with potential beneficial and adverse side effects. Understanding the impact of various ventilation strategies allows clinicians to provide optimal care for patients.
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Affiliation(s)
| | - Daniel R. Brown
- Department of Anesthesia, Division of Critical Care, Mayo Clinic, Rochester, Minnesota,
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23
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Khraim FM. The Wider Scope of Video-Assisted Thoracoscopic Surgery. AORN J 2007; 85:1199-1208; quiz 1209-12. [PMID: 17560858 DOI: 10.1016/j.aorn.2007.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Indexed: 11/15/2022]
Abstract
In the past, rudimentary devices were used to look closely into the chest; currently, advanced video technology, computers, and high-tech electronics are being used to perform many surgical procedures that formerly required a large, open incision. The goal of video-assisted thoracoscopic surgery (VATS) is the same as for comparable open procedures, but it is accomplished with less pain, less patient morbidity, and a shorter hospital stay. In addition to evaluating and treating thoracic injuries, VATS has demonstrated effectiveness in detecting and managing many other conditions, such as pleural disease, interstitial lung disease, and thoracic malignancies.
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Affiliation(s)
- Fadi M Khraim
- University of New York at Buffalo, School of Nursing, USA
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Neragi-Miandoab S. Malignant pleural effusion, current and evolving approaches for its diagnosis and management. Lung Cancer 2006; 54:1-9. [PMID: 16893591 DOI: 10.1016/j.lungcan.2006.04.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2006] [Revised: 04/01/2006] [Accepted: 04/11/2006] [Indexed: 10/24/2022]
Abstract
Malignant pleural effusion is a common and debilitating complication of advanced malignant diseases. This problem seems to affect particularly those with lung and breast cancer, contributing to the poor quality of life. Approximately half of all patients with metastatic cancer develop a malignant pleural effusion at some point, which is likely to cause significant symptoms such as dyspnea and cough. Evacuation of the pleural fluid and prevention of its re-accumulation are the main goals of management. Optimal treatment is controversial and there is no universally standard approach. Intervention options range from observation in the case of asymptomatic effusions through simple thoracentesis to more invasive methods such as chemical and mechanical pleurodesis, pleur-X catheter drainage, pleuroperitoneal shunting, and pleurectomy. The best results are reported with thoracoscopy and talc insufflation, with an acceptable morbidity. Development of novel methods to control malignant pleural effusion should be a high priority in palliative care of cancer patients. This article reviews the current, as well as, novel approaches that show some promise for the future. The aim is to identify the proper approach for each individual patient.
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Affiliation(s)
- Siyamek Neragi-Miandoab
- Thoracic and Cardiovascular Surgery, Loyola University Chicago, Stritch School of Medicine, 2160 South First Ave., Building 110, Room 6243, Maywood, IL 60153, USA.
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