Abstract
The expanding realm of minimally invasive surgery incorporate specific anaesthetic challenges. This report transcribes the anaesthetic technique for the first successful Transoral Endoscopic Thyroidectomy (TOET) performed in Sri Lanka using 3-dimensional (3D) endoscopy at National Hospital of Sri Lanka.
Highlights
Invasive TOET has been in development since Gagner’s endoscopic subtotal parathyroidectomy in 19961
Lung protective ventilatory strategy was employed with tidal volumes of 7ml/kg, respiratory rate of 12/min and a positive endexpiratory pressure of 5cmH2O
A reinforced nasal tube was inserted to obviate the possibility of endotracheal tube (ETT) disconnection during surgery with a throat pack inserted to prevent aspiration
Summary
Invasive TOET has been in development since Gagner’s endoscopic subtotal parathyroidectomy in 19961. Advantages of this method include elimination of a surgical neck scar, less bleeding, reduced analgesic requirement and a faster recovery. Lung protective ventilatory strategy was employed with tidal volumes of 7ml/kg, respiratory rate of 12/min and a positive endexpiratory pressure of 5cmH2O. Peak airway pressure (Paw) stood around 22cmH2O. End tidal CO2 (ETCO2) at the beginning of the surgery stood between 35-40mmHg. The surgeon occupied the head-end throughout the surgery. ETCO2 and endoscopic working pressure were monitored continuously. Minute ventilation was adjusted to keep ETCO2 between 30-40mmHg by increasing the respiratory rate up to 16/min. Oral fluids were started immediately after surgery and feeding resumed the following day. Patient was discharged home on the second postoperative day
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