CO<sub>2</sub> during single incisional thoracoscopic bleb resection with two-lung ventilation
- Authors
- Lee, Dong Kyu; Kim, Heezoo; Kim, Hyun Koo; Chung, Doug Ik; Han, Kook Nam; Choi, Young Ho
- Issue Date
- Aug-2018
- Publisher
- AME PUBLISHING COMPANY
- Keywords
- Pneumothorax; video-assisted thoracoscopic surgery (VATS); minimally invasive surgical procedures; feasibility studies; carbon dioxide
- Citation
- JOURNAL OF THORACIC DISEASE, v.10, no.8, pp 5057 - 5065
- Pages
- 9
- Journal Title
- JOURNAL OF THORACIC DISEASE
- Volume
- 10
- Number
- 8
- Start Page
- 5057
- End Page
- 5065
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/74572
- DOI
- 10.21037/jtd.2018.07.79
- ISSN
- 2072-1439
2077-6624
- Abstract
- Background: CO2 insufflation could provide a better surgical field during single-incision thoracoscopic surgery (SITS) with small tidal two-lung ventilation (ST-TLV). Here we compared the surgical field and physiological effects of ST-TLV with and without CO2 during SITS. Methods: Patients underwent scheduled SITS bullectomy. Surgery under ST-TLV general anesthesia performed without CO2 (group NC) or with CO2 insufflation (group C). The surgical field was graded at thoracoscope introduction and at bulla resection as follows: good (more than half of the 1st rib visible; bleb easily grasped with the stapler), fair (less than half of the 1st rib visible; some manipulation needed to grasp the bleb with the stapler), or poor (1st rib non-visible; bleb ungraspable). Vital signs, arterial blood gas analysis (ABGA), and mechanical ventilation parameters, postoperative chest tube indwelling duration, length of hospital stays, and complications were recorded. Results: A total of 80 patients were ultimately included. The surgical field at thoracoscope introduction was better in group C (P=0.022). However, at bleb resection, the surgical fields did not differ (P=0.172). The operation time was significantly longer in group C (P=0.019) and anesthesia recovery time was not different (P=0.369). During the CO2 insufflation, the airway pressure was higher in group C (P=0.009). Mean PaCO2 was significantly higher (P=0.012) and mean PaO2 was significantly lower (P=0.024) in group C, but both values were within the physiologically normal range. Postoperative chest tube indwelling duration and length of hospital stays were not statistically different (P=0.234 and 0.085 respectively). Postoperative complication frequencies were similar (12.5% for group NC, 10.0% for group C, P=0.723). Conclusions: SITS with CO2 insufflation during ST-TLV did not produce a superior surgical field except at the beginning of surgery. CO2 insufflation required more time and resulted in higher mean PaCO2 and peak airway pressure.
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