The application of single-lumen endotracheal tube anaesthesia with artificial pneumothorax in thoracolaparoscopic oesophagectomy

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.

Improvement Of Surgical Complications Using Single-Lumen Endotracheal Tube Intubation And Artificial Carbon Dioxide Pneumothorax In Esophagectomy: A Meta-analysis

“…Two studies were literature reviews (10,11). Finally, four case control studies were included in this meta-analysis (12)(13)(14)(15).…”

“…If we excluded the study by Zhang (12) because all groups in the study used CO 2 in ation, the pooled odds ratio was 0.775 (95% CI: 0.520 to 1.154) ( Figure 2b). The pooled odds ratio for anastomosis leakage in SLET group versus DLET group was 1.056 (95% CI: 0.769 to 1.451) ( Figure 3a).…”

Upper Gastrointestinal Surgery: Robotic Surgery versus Laparoscopic Procedures for Esophageal Malignancy

“…While the prone position takes advantage of gravity to displace the lung from the dorsal thoracic structures and the esophagus, the lateral position allows for an approach similar to open resection and does not require repositioning of the patient in the case a conversion to open surgery is required during the transthoracic resection phase. Most centers use single-lung ventilation with active CO 2 insufflation into the right hemithorax during the thoracic phase; however, the prone position in some patients also allows for double-lung ventilation during the thoracic phase [21]. Respiratory management deserves recognition when discussing MIE, as one of the leading arguments for the introduction of a minimally invasive approach is the reduction of pulmonary complications.…”

Anaesthesia during oesophagectomy

“…During minimally invasive transthoracic and trans-hiatal surgery the use of one lung ventilation may not be obligatory. One Chinese group reported the use of single lumen intubation for thoracoscopy as feasible and safe (35). Indeed, the need for OLV might also depend on the position of the anastomosis and the need for optimal surgical views.…”