A comparison of bronchial blocker under artificial pneumothorax and double-lumen endobronchial tube for lung isolation in thoracoscopic enucleation of oesophageal leiomyoma

Luo Zhao,Jia He,Xue Zhang,Zhijun Han,Chao Gao,Li Li

doi:10.1186/s13019-021-01707-4

Abstract

BackgroundOesophageal leiomyomas are one of the most common benign oesophageal tumours. This retrospective, observational study summarized and compared the clinical outcomes of thoracoscopic enucleation of oesophageal leiomyoma between single-lumen endotracheal intubation with a bronchial blocker and double-lumen endotracheal intubation.MethodsA total of 36 patients who underwent thoracoscopic enucleation of oesophageal leiomyoma at Peking Union Medical College Hospital between 2014 and 2020 were retrospectively analysed. Fifteen patients received single-lumen endotracheal intubation combined with a right bronchial blocker (SLT-B group), and twenty-one patients received double-lumen endotracheal intubation (DLT group). Clinical data, surgical variables, and postoperative complications were analysed and compared.ResultsThe average tumour size in all patients was 4.3 ± 2.0 cm. The average tumour size among symptomatic patients was significantly larger than that among asymptomatic patients (5.1 ± 2.0 cm vs 3.7 ± 1.7 cm, P < 0.05). Patients in the SLT-B group had a significantly larger average tumour size than patients in the DLT group (5.4 ± 2.1 cm vs 3.5 ± 1.4 cm, P < 0.05). The SLT-B group had a significantly shorter operation time and shorter total hospital stay than the DLT group. No mucosal injury, conversion to thoracotomy, or other operative complications occurred in the SLT-B group. In the follow-up, no recurrence, dysphagia, or regurgitation was found in any of the patients.ConclusionsCompared with traditional double-lumen intubation, artificial pneumothorax-assisted single-lumen endotracheal intubation combined with a bronchial blocker for thoracoscopic oesophageal leiomyoma enucleation can achieve complete removal of larger tumours, with fewer complications and shorter hospital stays.

Highlights

Oesophageal leiomyomas are the most common benign oesophageal tumours, accounting for approximately 70%—80% of oesophageal submucosal tumours [1]
We present surgical outcomes of video-assisted thoracoscopic enucleation of oesophageal leiomyoma and evaluate the advantages of single-lumen endotracheal intubation combined with a bronchial blocker under artificial pneumothorax compared with traditional double-lumen endotracheal intubation
All patients were diagnosed with oesophageal leiomyoma by postoperative pathology, and the tumour location was evaluated by gastroscopy, upper gastrointestinal angiography and enhanced computed tomography of the chest and abdomen

Summary

Introduction

Oesophageal leiomyomas are the most common benign oesophageal tumours, accounting for approximately 70%—80% of oesophageal submucosal tumours [1]. Compared with double-lumen endotracheal intubation anaesthesia, single-lumen endotracheal intubation combined with a bronchial blocker under artificial pneumothorax is an improved lung separation technology. Artificial pneumothorax achieves better lung collapse and surgical field exposure and decreases blood loss, which are more convenient for tumour enucleation with less morbidity [3]. We present surgical outcomes of video-assisted thoracoscopic enucleation of oesophageal leiomyoma and evaluate the advantages of single-lumen endotracheal intubation combined with a bronchial blocker under artificial pneumothorax compared with traditional double-lumen endotracheal intubation. Oesophageal leiomyomas are one of the most common benign oesophageal tumours. This retrospective, observational study summarized and compared the clinical outcomes of thoracoscopic enucleation of oesophageal leiomyoma between single-lumen endotracheal intubation with a bronchial blocker and double-lumen endotracheal intubation

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Results

Discussion

Conclusion