Two-lung Ventilation Technique for Thoracolaparoscopic Esophagectomy in Prone Position

Daisuke Saikawa, MD, Shunichi Okushiba, MD PhD, Saseem Puedel, MD, Takanobu Onoda, MD, Takeshi Sasaki, MD PhD, Yuma Ebihara, MD PhD, Yo Kawarada, MD PhD, Shuji Kitashiro, MD PhD, Hiroyuki Kato, MD PhD. tonan hospital


Thoracolaparoscopic esophagectomy (TLE) in prone position has become common because of better visibility and operability. Inplementing the technique of TLE in prone position requires some special skills and knowledge beside surgical technique especially anesthesia management. One side ventilation is common in TLE in prone position, but it makes the anesthesia induction andmanagement cumbersome and complicated. Since 2008, we have been performing esophagectomy with single-lumen endotracheal tube with possible two-lung ventilation. And we use artifical pneumothrax by carbon dioxide to deflate the right lung and keep the surgical field clear. This technique does not mean only simplicity of anesthesia but also an excellent surgical field because of tracheal mobility due to single lumen endotracheal tube intubation. Now we are going to present the unique surgical approach that strips off the ventral side of esophagus first. We have also researched respiration and circulation dynamics under the two lung ventilation with artifical pneumothrax in prone position using FloTrac System(Edwards lifesciences). 8 patients were treated and the result is that as follows: mean cardiac index is 2.6L/min/m2 , mean central venous pressure is 10.4cmH2O, and mean usage of dopamine agonist is 0.8γ under the artifical pneumothrax with 8cmH2O carbon dioxide. On the other hand, respiratory condition is this : the peak airway pressure of 8 patient average is 20.4cmH2O,and mean PaO2 / FiO2:ratio is 267. When left side pleura is injured and both side artifical pneumothrax is indeced, we observe an increased airway pressure and decreased tidal volume, but circulation dynamics is unchanged. Although this data is not enough number, we consider two-lung ventilation tequnique is feasible and has many advantages.

Session Number: Poster – Poster Presentations
Program Number: P213
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