Efficacy and safety of artificial pneumothorax under two-lung ventilation in thoracoscopic esophagectomy for esophageal cancer in the prone position

Saikawa, Daisuke; Okushiba, Shunichi; Kawata, Masaya; Okubo, Torahiko; Kitashiro, Shuji; Kawarada, Yo; Kato, Hiroyuki

doi:10.1007/s11748-013-0335-0

Cited by 41 publications

(24 citation statements)

References 10 publications

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“…Recently, researchers from Japan reported a result of thoracoscopic-esophagectomy for 14 patients in prone position with TLV and artificial pneumothorax, in which they showed a stable perioperative hemodynamics and oxygenation (10). And Bonavina indicated the thoracoscopic esophagectomy in prone position with TLV was a safer and more effective operation procedure by compared to the Ivor Lewis operation (26,27).…”

Section: Discussionmentioning

confidence: 99%

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Better perioperative outcomes in thoracoscopic-esophagectomy with two-lung ventilation in semi-prone position

Li¹,

Sun²,

Yang³

et al. 2017

J. Thorac. Dis.

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Background: One-lung ventilation (OLV) anesthesia intubation route is often used in patients undergoing thoracoscopic-esophagectomy in semi-prone position. Recently, the two-lung ventilation (TLV) approach becomes popular. However, limited studies have compared the two ventilation approaches in parallel. Here, we report a single-center, retrospective study of comparing TLV and OLV approach in patients undergoing thoracoscopic-esophagectomy in semi-prone position. Conclusion: This study demonstrated that TLV intubation approach is superior to OLV approach during the thoracoscopic-esophagectomy in semi-prone position. According to this, TLV approach is a technically feasible, convenient and safe anesthesia induction approach for esophageal cancer surgery.

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Section: Discussionmentioning

confidence: 99%

“…The TLV with a single-lumen endotracheal tube has rapidly gained popularity and seems to be a promising option for MIE (10,11). However, limited studies have compared the TLV and OLV in patients undergoing thoracoscopic-esophagectomy in a position of semi-prone.…”

Section: Introductionmentioning

confidence: 99%

Better perioperative outcomes in thoracoscopic-esophagectomy with two-lung ventilation in semi-prone position

Li¹,

Sun²,

Yang³

et al. 2017

J. Thorac. Dis.

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“…Rino et al (2014) reported that the use of absorbable dense knit hemostat, instead of an electrocautery device, for hemostasis around the RLN could prevent the RLNP during esophageal cancer surgery. Thoracoscopic esophagectomy has been employed as minimally invasive surgery (Saikawa et al 2014;Koyanagi et al 2015). Although magnification of the surgical fields can enable a precise lymph node dissection along the RLN, the advantages of a thoracoscopic esophagectomy for reducing the RLNP continues to be debated.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Laryngeal Nerve Paralysis after Esophagectomy: Respiratory Complications and Role of Nerve Reconstruction

Koyanagi

Igaki

Iwabu

et al. 2015

Tohoku J. Exp. Med.

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Recurrent laryngeal nerve paralysis (RLNP) after esophagectomy is a common complication and associated with aspiration pneumonia. In this study, we assessed the risk of RLNP and the usefulness of immediate reconstruction of recurrent laryngeal nerve (RLN) to prevent respiratory complications after esophagectomy. Seven hundred and eighty-two consecutive patients underwent an esophagectomy with three-field lymph node dissection, simultaneous gastric conduit reconstruction, and cervical anastomosis. Vocal cord function was observed using a flexible laryngoscope. Reconstruction between RLN and ipsilateral vagus nerve was performed during esophagectomy. RLNP was observed in 229 (29.3%) of the patients after esophagectomy: 198 unilateral and 31 bilateral cases. Of the 198 unilateral RLNP, vocal cord paralysis was observed predominantly on the left side (82.7%). RLNP was significantly associated with postoperative respiratory complications (P < 0.001) requiring a tracheotomy (P < 0.001) and mechanical ventilation (P < 0.001) and was also associated with esophagogastric anastomotic leakage (P = 0.015); consequently, the postoperative hospital stay was longer for patients with RLNP (P < 0.001). A longer operation time (P < 0.001) and advanced age (P = 0.038) were identified as significant independent predictors of RLNP. Resection of the RLN together with metastatic nodes was performed in 29 cases. The patients underwent RLN reconstruction (n = 11) had a significantly shorter postoperative hospital stay than those without RLN reconstruction (n = 18) (P = 0.019). In conclusion, RLNP was related to a poorer postoperative course among patients undergoing an esophagectomy. New surgical technologies are recommended for prevention of RLNP.

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“…A recent, larger, randomized controlled trial did however report a reduction in pulmonary complication, including ALI/ARDS, in patients undergoing minimally invasive esophagectomy with lung protective ventilation (5 vs. 8 mL/Kg tidal volume and 5 cmH 2 O positive end‐expiratory pressure) . Another study determined that artificial pneumothorax with maintenance of two‐lung ventilation was both safe and efficacious in the context of thoracoscopic esophagectomy in the prone position …”

Section: Approaches To Reducing Pulmonary Morbidity After Esophagectomymentioning

confidence: 99%

Pathophysiology of acute lung injury following esophagectomy

2014

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KEY WORDS: acute lung injury, acute respiratory distress syndrome, esophagectomy, pathophysiology, postoperative complications.Esophagectomy is widely considered to be a high risk surgical approach. While improvements in surgical technique, perioperative monitoring, and postoperative care have led to a reduction in mortality following esophagectomy, early mortality remains between 5% and 10%. 1,2 Moreover, postoperative complications, involving predominantly the cardiorespiratory system, occur in up to 50% of patients. 3 Of the numerous respiratory complications that are associated with esophagectomy, acute lung injury (ALI) and its more severe form acute respiratory distress syndrome (ARDS) are of notable significance due to their prevalence and impact on early morbidity and mortality. 4 Reported rates of ALI and ARDS following esophagectomy are 23.8% and 14.5% respectively, the latter associated with 50% mortality. 4 While the existence of an accepted clinical definition for ALI/ARDS 5 has greatly contributed to the wider study of ALI/ARDS, continued variability in reporting practices has meant that the pathophysiology of this syndrome in the context of esophagectomy remains incompletely understood. Notwithstanding, patient-specific factors, the extent and nature of surgical trauma, and frequent requirement for periods of one-lung ventilation (OLV) are all anticipated to contribute to the development of ALI/ARDS following esophagectomy through their influence on systemic and local inflammatory responses. Consequently, the aim of this review is to define the pathophysiology of ALI/ARDS in the setting of esophagectomy and to explore potential strategies for prediction and prevention of this complication. PATHOPHYSIOLOGY OF ALI/ARDSAs first described by Ashbaugh et al. in 1967, ALI/ ARDS is recognized as a constellation of clinical, radiological, and physical abnormalities that collectively define an underlying picture of diffuse damage to the alveolar capillary unit and associated pulmonary gas exchange disturbance. 6 Central to this process is disruption of vascular endothelial and pulmonary epithelial linings and subsequent flooding of the alveolar and interstitial spaces with proteinaceous fluid, rich in inflammatory mediations and leukocytes. 7 Causes of ALI/ARDS can be broadly divided between those that result in either direct or indirect lung injury. Common sources of direct lung injury include: pneumonia, aspiration, trauma, reperfusion, and inhalation injury. Alternatively, sepsis, shock, polytrauma, and blood transfusion are common sources of indirect lung injury. 8 In patients undergoing esophagectomy precipitants of ALI/ARDS may reflect both local and systemic insults.

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Efficacy and safety of artificial pneumothorax under two-lung ventilation in thoracoscopic esophagectomy for esophageal cancer in the prone position

Cited by 41 publications

References 10 publications

Better perioperative outcomes in thoracoscopic-esophagectomy with two-lung ventilation in semi-prone position

Better perioperative outcomes in thoracoscopic-esophagectomy with two-lung ventilation in semi-prone position

Recurrent Laryngeal Nerve Paralysis after Esophagectomy: Respiratory Complications and Role of Nerve Reconstruction

Pathophysiology of acute lung injury following esophagectomy

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