Robotic‐assisted cardiac surgery without lung isolation utilizing single‐lumen endotracheal tube intubation

Abstract

Objectives This study assessed the feasibility and outcomes of performing robotic cardiac surgery without lung isolation using single‐lumen (SL) endotracheal tube intubation. Methods Between 2013 and 2017, 132 patients underwent robotically‐assisted atrial septal defect closure. A retrospective analysis was performed of 23 patients (11 males, mean age 30.9 ± 5 years) who underwent robotic surgery with double‐lumen (DL) endotracheal tube intubation (group 1) compared with 109 patients (57 males, mean age 32.4 ± 7.5 years) undergoing the same procedure with SL endotracheal intubation (group 2). The patient groups were compared in terms of demographic characteristics, operative data, and complications. The technical feasibility of the robotic procedure without lung isolation was evaluated. Results There were no mortality, intraoperative complication, and conversion. Mean total anesthesia time was significantly decreased in the SL intubation group (238.3 ± 22.4 vs 227.2 ± 21.2 minutes; P = .025). First‐pass intubation success was significantly higher in the SL intubation group (17 [73.9%] vs 98 [89.9%] patients; P = .032). Mean ventilation time (10.9 ± 5.3 hours), intensive care unit stay (16.8 ± 10.1 hours), and the length of hospital stay (3.8 ± 1.2 days) was significantly decreased in patients with SL tube (P < .05). Unilateral reexpansion pulmonary edema was observed in five (21.7%) patients with DL tube, whereas no patient with SL tube had this complication. Conclusions SL endotracheal tube intubation without lung isolation is a feasible and safe airway alternative in robotic cardiac procedures. This approach resulted in shorter anesthesia time, ventilation time and the length of hospital stay. Port placement and robotic set‐up can be uneventfully performed without lung isolation.

Robotic-assisted thoracoscopic resection of anterior mediastinal cystic teratoma: a case report and literature review

“…In this case, we attempted resection with the patient supine and with DLV in order to facilitate a safe dissection with minimal OR time and without the associated complexity of a dual lumen ET tube. Placement of a dual lumen ET tube can require multiple intubation attempts resulting in complications such as tracheobronchial tree injury, hypoxemia, bleeding, and bronchospasms [ 14 ]. However, intraoperatively, the extent of the anterior mediastinal involvement of the teratoma was more than that seen on pre-operative CT scans, as the tumor was found to be invading the anterior upper and middle lung lobes, right phrenic nerve, and the SVC.…”

“…However, patients are often able to tolerate up to 10-15 mmHg of intrathoracic pressure without any hemodynamic compromise [ 13 ]. Similarly, in a retrospective study of patients undergoing minimally invasive atrial septal defects with either SLV or DLV, Sen et al [ 14 ] showed that DLV resulted in decrease operative time, intensive care and hospital stay, and complications such as re-expansion pulmonary edema. Moreover, they showed a higher first-pass intubation rate with DLV (89.9%) compared to SLV (73.9%), with two patients in the SLV group developing significant airway edema requiring ICU level of care [ 14 ].…”

“…Similarly, in a retrospective study of patients undergoing minimally invasive atrial septal defects with either SLV or DLV, Sen et al [ 14 ] showed that DLV resulted in decrease operative time, intensive care and hospital stay, and complications such as re-expansion pulmonary edema. Moreover, they showed a higher first-pass intubation rate with DLV (89.9%) compared to SLV (73.9%), with two patients in the SLV group developing significant airway edema requiring ICU level of care [ 14 ]. These two studies support the trend towards minimally invasive thoracoscopic resections along with the selective use of double lung ventilation in order to reduce operative time, cost, and complications associated with a dual lumen ET tube.…”

“…This case highlights the successes of performing a minimally invasive thoracoscopic resection of an anterior mediastinal tumor as well as the limitations of using double lung ventilation. Performing this resection via a median sternotomy provides the best anatomic exposure as teratomas can be large and invasive [ 14 , 15 ] however, thoracoscopic resection minimizes the morbidity associated with a median sternotomy with equivalent outcomes [ 16 ]. In a retrospective review comparing VATS with double lung ventilation vs sternotomy for early stage thymoma, Pennathur et al [ 17 ] showed comparable oncological outcomes and decreased hospital stay in the VATS group.…”

The anesthesia management of totally thoracoscopic cardiac surgery: A single-center retrospective study

“…LV, Left ventricle; RV, Right ventricle; MV，Mitral valve. Left-double lumen endotracheal intubation: During TTCS, airway management is generally achieved with lung isolation using left-double lumen endotracheal intubation or single-lumen tubes with bronchial blockers [ 39 , 40 ]. At our center, all patients underwent video laryngoscopy and fiberoptic bronchoscopy guided left double-lumen endotracheal intubation to obtain adequate exposure and visualization during TTCS ( Fig.…”