Single-lumen Endotracheal Intubation Research Articles

Video Laryngoscopy vs Direct Laryngoscopy for Endotracheal Intubation in the Operating Room

Endotracheal tubes are typically inserted in the operating room using direct laryngoscopy. Video laryngoscopy has been reported to improve airway visualization; however, whether improved visualization reduces intubation attempts in surgical patients is unclear. To determine whether the number of intubation attempts per surgical procedure is lower when initial laryngoscopy is performed using video laryngoscopy or direct laryngoscopy. Cluster randomized multiple crossover clinical trial conducted at a single US academic hospital. Patients were adults aged 18 years or older having elective or emergent cardiac, thoracic, or vascular surgical procedures who required single-lumen endotracheal intubation for general anesthesia. Patients were enrolled from March 30, 2021, to December 31, 2022. Data analysis was based on intention to treat. Two sets of 11 operating rooms were randomized on a 1-week basis to perform hyperangulated video laryngoscopy or direct laryngoscopy for the initial intubation attempt. The primary outcome was the number of operating room intubation attempts per surgical procedure. Secondary outcomes were intubation failure, defined as the responsible clinician switching to an alternative laryngoscopy device for any reason at any time, or by more than 3 intubation attempts, and a composite of airway and dental injuries. Among 8429 surgical procedures in 7736 patients, the median patient age was 66 (IQR, 56-73) years, 35% (2950) were women, and 85% (7135) had elective surgical procedures. More than 1 intubation attempt was required in 77 of 4413 surgical procedures (1.7%) randomized to receive video laryngoscopy vs 306 of 4016 surgical procedures (7.6%) randomized to receive direct laryngoscopy, with an estimated proportional odds ratio for the number of intubation attempts of 0.20 (95% CI, 0.14-0.28; P < .001). Intubation failure occurred in 12 of 4413 surgical procedures (0.27%) using video laryngoscopy vs 161 of 4016 surgical procedures (4.0%) using direct laryngoscopy (relative risk, 0.06; 95% CI, 0.03-0.14; P < .001) with an unadjusted absolute risk difference of -3.7% (95% CI, -4.4% to -3.2%). Airway and dental injuries did not differ significantly between video laryngoscopy (41 injuries [0.93%]) vs direct laryngoscopy (42 injuries [1.1%]). In this study among adults having surgical procedures who required single-lumen endotracheal intubation for general anesthesia, hyperangulated video laryngoscopy decreased the number of attempts needed to achieve endotracheal intubation compared with direct laryngoscopy at a single academic medical center in the US. Results suggest that video laryngoscopy may be a preferable approach for intubating patients undergoing surgical procedures. ClinicalTrials.gov Identifier: NCT04701762.

Lung isolation—a personalized and clinically adapted approach to control bronchoscopy-associated acute massive airway hemorrhage

BackgroundThe current concept of bronchoscopy-associated massive airway hemorrhage is not accurate enough, and the amount of bleeding as the only evaluation criterion cannot comprehensively evaluate magnitude of the effects and the severity.ObjectiveTo propose the concept of bronchoscopy-associated acute massive airway hemorrhage, analyze its impact on patients and highlight the treatment approach of acute massive airway hemorrhage without ECMO support.DesignsA retrospective cohort study.SettingInclude all patients who received bronchoscopy intervention therapy at Interventional Pulmonology Center of Emergency General Hospital from 2004 to December 2021.Patients223 patients met the inclusion criteria.InterventionPatients were divided into two groups: acute massive airway hemorrhage group (n = 29) and non-acute massive airway hemorrhage group (n = 194).Main outcome measuresPerioperative adverse events between two groups were the main outcome. Secondary outcome was the impact of lung isolation on patient in group Acute.ResultsThe incidence of acute massive airway hemorrhage was 0.11%, and the incidence of non-acute massive airway hemorrhage was 0.76% in this study. There were significant differences in the incidence of intraoperative hypoxemia, lowest SpO2, hemorrhagic shock, cardiopulmonary resuscitation, intraoperative mortality, and transfer to ICU between acute group and non-acute group (P<0.05, respectively). Lung isolation was used in 12 patients with acute massive airway hemorrhage, and only 2 patients died during the operation.ConclusionBronchoscopy-associated acute massive airway hemorrhage had more serious impact on patients due to rapid bleeding, blurred vision of bronchoscopy, inability to stop bleeding quickly, blood filling alveoli, and serious impact on oxygenation of the lung lobes. Polyvinyl chloride single-lumen endotracheal intubation for lung isolation, with its characteristics of low difficulty, wide applicability and available in most hospitals, may reduce the intraoperative mortality of patients with bronchoscopy-associated acute massive airway hemorrhage.Trial registrationChinese Clinical Trial Registry on 13/03/2022. Registration number: ChiCTR2200057470.

The ED50 of Remazolam Toluenesulfonate Combined with a Subthreshold Dose of Esketamine for Inhibiting Cardiovascular Response to Tracheal Intubation in Elderly Patients

Objective: To explore the half-effective dose (ED50) of remazolam toluenesulfonate combined with subthreshold amounts of esketamine for inhibiting cardiovascular response to tracheal intubation in elderly patients. Method: We included 42 patients, aged 65–75, who required general anesthesia and single-lumen endotracheal intubation for elective surgery. The first patient was administered remazolam toluenesulfonate at a dose of 0.20 mg/kg. Once the patient lost consciousness, their alertness/sedation score (OAA/S score) was ≤ 1, and their BIS score was ≤ 60, and a subthreshold dose (0.3 mg/kg) of esketamine was given. The subsequent doses were adjusted using a sequential approach based on the cardiovascular response to tracheal intubation observed in the previous patient. The dose was modified in increments or decrements of 0.01 mg/kg. The ED50 and 95% CI of remazolam toluenesulfonate were calculated using the Dixon and Massey sequential distribution test method. Result: The inhibition of endotracheal intubation response was positively correlated with the dose of remazolam toluenesulfonate, and the depth of sedation could not be achieved when the amount was ≤ 0.22 mg/kg. The ED50 of remazolam toluenesulfonate combined with a subthreshold dose of esketamine in inhibiting cardiovascular response to tracheal intubation in elderly patients was 0.30 (0.28, 0.33) mg/kg. There was no statistically significant difference in blood pressure between the induction of anesthesia and before the operation. Conclusion: When compounded with 0.3 mg/kg esketamine, the ED50 of Remazolam toluenesulfonate in inhibiting cardiovascular response to endotracheal intubation in elderly patients was 0.30 mg/kg (95 % CI0.28–0.33 mg/kg).

Main steps for closing a 3.5 cm post intubation tracheal laceration in a 63-year-old woman after elective single-lumen endotracheal intubation for vocal cords polyp surgery.

Main steps for closing a 3.5 cm post intubation tracheal laceration in a 63-year-old woman after elective single-lumen endotracheal intubation for vocal cords polyp surgery.

MIDCAB Versus Off-Pump CABG: A Comparative Study

Introduction: Treatment for coronary artery disease (CAD) includes medical therapy, percutaneous coronary intervention (PCI) and coronary artery bypass grafting. Objectives: The main objective of the study is to find the comparison of MIDCAB vs open off-pump procedure CABG for single vessel coronary disease. Material and methods: This comparative analysis was conducted at Rawalpindi Institute of Cardiology, Armed Forces Institute of Cardiology, Rawalpindi and Shifa International Hospital, Islamabad from October 2019 to 2021. Informed consent was taken from all the patients before collecting the data. Patients in the MIDCAB group received sub-station hybridization to treat the diseased vessels except the left anterior descending (LAD). Patients in the OPCAB group were placed in the supine position, and combined intravenous inhalational anaesthesia was given; then, single-lumen endotracheal intubation was performed through the median incision. Results: The data were collected from 100 coronary artery disease patients. The mean age of the study patients was 54.4±10.6 years. Cigarette smoking was much more common in men than in women (32.6% vs. 0, p&lt;0.001). The serum levels of creatinine, uric acid, and cTAS were significantly higher in men than in women (0.9±0.2 vs. 0.7±0.1, 7.6±2.1 vs. 6.8±2.3, and.0.4±0.0 vs. 0.3±0.1, respectively; p&lt;0.001). Conclusion: It is concluded that MIDCAB procedures can be performed with similar safety as OPCAB procedures. Postoperative outcomes in terms of mortality were satisfactory, rendering this procedure at least as safe as the option of OPCAB. Practical implications: MIDCAB is considered to be the safe procedure and we may practically use this method. Key words: MIDCAB, OPCAB, Mortality, Coronary Artery Diseases, Procedures

Anesthetic management of heart and lung transplantation: analysis of 14 cases in a single center

BackgroundAggressive management of heart and lung transplant (HLTx) requires a team of specialists with dedicated expert to improve long-term outcomes. This study aimed to summarize practical experiences of anesthetic management in HLTx operations.MethodsThis study retrospectively analyzed the anesthesia-related clinical records of 14 cases of HLTx performed from September 2015 to October 2019. Preoperative diagnoses included congenital heart disease with pulmonary arterial hypertension, idiopathic pulmonary arterial hypertension with right heart failure, end-stage cor pulmonale, dilated cardiomyopathy, end-stage heart failure with pulmonary arterial hypertension, congenital heart disease, and lung transplant failure. All recipients received intravenous-inhalation general anesthesia with single-lumen endotracheal intubation, Swan-Ganz catheterization, and transesophageal echocardiography (TEE).ResultsAll 14 cases of HLTx were completed successfully and the patients were transferred to the intensive care units (ICUs). The postoperative data of the 14 patients were collected from 1 month to 4 years: seven cases survived the first year, four cases died in the short term (within 30 days), and one case died within 24 h. As at the end of November 2019, eight cases were reported dead (the longest survival was 2 years 1 month and 22 days). Four cases used extracorporeal membrane oxygenation (ECMO) for cardiopulmonary support.ConclusionsThe success of the HLTx was attributed to the joint efforts of the entire transplantation team. The anesthesiology team was required for experiences in anesthesia for HLTx. The key to anesthesia management was the in-depth participation in preoperative discussions and assessments. Preventing the exacerbation of right heart failure and pulmonary arterial hypertension is critical during the induction of anesthesia. Regulation and support are crucial from the withdrawal of cardiopulmonary bypass (CPB) to within 1 h of the circulation and respiratory functions undertaken independently by the donor heart and lungs.

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

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.

Application of different kinds of endotracheal intubation in the combined thoracoscopic and laparoscopic esophagectomy

Objective: To observe the application of three different kinds of endotracheal intubation in the combined thoracoscopic and laparoscopic esophagectomy. Methods: one hundred and eighty patients undergoing combined thoracoscopic and laparoscopic esophagectomy under general anesthesia from the Affiliated Cancer Hospital of Zhengzhou University from February to September 2019 were randomly divided into three groups which include: double-lumen endotracheal intubation group (group S,n=60),single-lumen endotracheal intubation group (group D,n=60) and Coopdech occlusion of bronchial catheter combined with a single-lumen endotracheal intubation group (group C,n=60). The arterial blood samples were collected immediately after endotracheal intubation (T0), 30 min after artificial pneumothorax (single lung ventilation) (T1), 30 min after artificial pneumothorax (double lung ventilation) (T2), and 30 min after extubation (T3) to detect arterial blood gas. Patients' heart rate (HR), blood oxygen partial pressure (PaO2), blood carbon dioxide partial pressure (PaCO2) and airway pressure(Paw) were recorded at T0-T3.Completion time of endotracheal intubation, carbon dioxide intrathoracic inflation pressure, degree of lung collapse and incidence of postoperative 3-day pneumonia in three groups were recorded. The bronchoalveolar lavage fluid (BALF) of patients at T0, T2 and the end of the operation (T4) were collected to detect the levels of tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6) and interleukin-8 (IL-8) in BALF by enzyme-linked immunosorbent assay (ELISA). Results: A total of 14 patients were excluded during the operation, of which 9 cases lasted longer than 6 hours, 3 cases had arrhythmia during the operation and 2 cases lasted less than 1 hour. Finally, 56 cases in group S, 54 cases in group D and 56 cases in group C completed the experiment. The satisfaction rates of lung collapse in group S, group D and group C were 85.7% (48/56), 100.0% (54/54), 89.2% (50/56), respectively, with no statistically significant difference (χ²=1.308, P>0.05). The intrathoracic inflation pressure of carbon dioxide in group D was (10.2±2.2) mmHg (1 mmHg=0.133 kPa), which was higher than (5.1±3.4) mmHg in group S and (5.6±3.1) mmHg in group C, the difference was statistically significant (F=-9.303, P<0.05). The incidence of postoperative 3-day pneumonia in group D was 14.8%, which was lower than 39.3% in group S and 17.8% in group C, the difference was statistically significant (χ²=8.300, P<0.05). At T4, the value of TNF-α in group D was (122.4±4.4) ng/L, which was lower than that in group S and group C, (257.9±6.3) and (185.8±5.6) ng/L, with statistically significant difference (F=69.020, P<0.05). At T4, the value of IL-6 in group D was (175.4±4.9) ng/L, which was lower than that of patients in group S and group C, (289.6±6.8) and (226.2±4.4) ng/L, with statistically significant difference (F=59.750, P<0.05). At T4, the value of IL-8 in group D was (303.1±7.2) ng/L, which was lower than in group S and group C, (595.4±22.1) and (436.8±10.9) ng/L, with statistically significant difference (F=55.359, P<0.05). Conclusion: All the three endotracheal intubations can produce satisfactory ventilation effect in the combined thoracoscopic and laparoscopic esophagectomy, however, single-lumen endotracheal intubation has less effect on lung injury.

Application of Right Bronchial Occlusion under Artificial Pneumothorax in the Thoracic Phase of Minimally Invasive McKeown Esophagectomy.

Purpose: To evaluate the feasibility and safety of single-lumen endotracheal intubation combined with right bronchial occlusion (SLET) under artificial pneumothorax in minimally invasive McKeown esophagectomy.Methods: A total of 165 patients who underwent minimally invasive McKeown esophagectomy at Peking Union Medical College Hospital were retrospectively analyzed. In all, 48 patients received double-lumen endotracheal intubation (DLET group), and 117 patients received SLET-B (SLET-B group). Clinical data, intraoperative hemodynamics, surgical variables, and postoperative complications were analyzed and compared.Results: Compared with the DLET group, a shorter intubation time and lower tube dislocation rate were found in the SLET-B group. In the thoracic phase, with the application of artificial pneumothorax, patients in the SLET-B group had lower partial pressure of carbon dioxide (PaCO2) and end-tidal carbon dioxide pressure (PetCO2) values and higher pH than those in the DLET group. Patients in the SLET-B group had shorter thoracic phase times and hospital stays and less intraoperative hemorrhage than those in the DLET group. The numbers of thoracic and bilateral recurrent laryngeal lymph nodes harvested were significantly higher in the SLET-B group.Conclusion: SLET under artificial pneumothorax is feasible and safe in minimally invasive McKeown esophagectomy.

GlideScope\xae versus C-MAC\xae(D) videolaryngoscope versus Macintosh laryngoscope for double lumen endotracheal intubation in patients with predicted normal airways: a randomized, controlled, prospective trial

BackgroundThe double lumen endotracheal tube (DLT) is the most widely-used device for single lung ventilation in current thoracic anesthesia practice. In recent years, the routine application of the videolaryngoscope for single lumen endotracheal intubation has increased; nevertheless there are few studies of the use of the videolaryngoscope for DLT. We wondered whether there were benefits to using the videolaryngoscope for DLT placement in patients with predicted normal airways. Therefore, this study was designed to compare the performances of the GlideScope®, the C-MAC®(D) videolaryngoscope and the Macintosh laryngoscope in DLT intubation.MethodsThis was a randomized, controlled, prospective study. We randomly allocated 90 adult patients with predicted normal airways into three groups. All patients underwent routine anesthesia using different laryngoscopes according to group allocation. We compared DLT insertion times, first-pass success rates, numerical rating scales (NRS) of DLT delivery and DLT insertion, Cormack-Lehane degrees (C/L), hemodynamic changes and incidences of intubation complications. All outcomes were analyzed using SPSS13.0.ResultsCompared with the GlideScope, the Macintosh gave shorter times for DLT insertion (median: 96 (IQR: 51 [min–max: 62–376] s vs 73 (26 [48–419] s, p = 0.003); however, there was no difference between the Macintosh and C-MAC(D) (p = 0.610). The Macintosh had a significantly higher successful first attempt rate than did the GlideScope or C-MAC(D) (p = 0.001, p = 0.028, respectively). NRS of DLT delivery and insertion were significantly lower in the Macintosh than in the others (p < 0.001). However, the C/L degree in the Macintosh was significantly higher than in the others (p < 0.001). The incidences of oral bleeding, hoarseness, sore throat and dental trauma were low in all groups (p > 0.05). There were no significant differences in DLT misplacement, fiberoptic time or hemodynamic changes among the groups.ConclusionsCompared with the Macintosh laryngoscope, the GlideScope® and C-MAC®(D) videolaryngoscopes may not be recommended as the first choice for routine DLT intubation in patients with predicted normal airways.Trial registrationThe study was prospectively registered at the Chinese Clinical Trial Registry (no. ChiCTR1900025718); principal investigator: Z.L.H.; date of registration: September 6, 2019.

Robotic‐assisted cardiac surgery without lung isolation utilizing single‐lumen endotracheal tube intubation

This study assessed the feasibility and outcomes of performing robotic cardiac surgery without lung isolation using single-lumen (SL) endotracheal tube intubation. Between 2013 and 2017, 132 patients underwent robotically-assisted atrial septal defect closure. A retrospective analysis was performed of 23 patients (11 males, mean age 30.9 ± 5 years) who underwent robotic surgery with double-lumen (DL) endotracheal tube intubation (group 1) compared with 109 patients (57 males, mean age 32.4 ± 7.5 years) undergoing the same procedure with SL endotracheal intubation (group 2). The patient groups were compared in terms of demographic characteristics, operative data, and complications. The technical feasibility of the robotic procedure without lung isolation was evaluated. There were no mortality, intraoperative complication, and conversion. Mean total anesthesia time was significantly decreased in the SL intubation group (238.3 ± 22.4 vs 227.2 ± 21.2 minutes; P = .025). First-pass intubation success was significantly higher in the SL intubation group (17 [73.9%] vs 98 [89.9%] patients; P = .032). Mean ventilation time (10.9 ± 5.3 hours), intensive care unit stay (16.8 ± 10.1 hours), and the length of hospital stay (3.8 ± 1.2 days) was significantly decreased in patients with SL tube (P < .05). Unilateral reexpansion pulmonary edema was observed in five (21.7%) patients with DL tube, whereas no patient with SL tube had this complication. SL endotracheal tube intubation without lung isolation is a feasible and safe airway alternative in robotic cardiac procedures. This approach resulted in shorter anesthesia time, ventilation time and the length of hospital stay. Port placement and robotic set-up can be uneventfully performed without lung isolation.

Single lumen endotracheal intubation with carbon dioxide insufflation for lung isolation in thoracic surgery

Double lumen tube (DLT) intubation is used for lung isolation but is not without disadvantages including increased intubation time, anesthesia expertise, risk of airway trauma, and costs over single lumen tube (SLT) intubation. SLT intubation with CO2 insufflation can be used as an alternative for lung isolation. We reviewed our experience with this technique during thoracoscopic surgery. We performed a retrospective review of a prospectively maintained IRB-approved database from 2009 to 2018. Operations were performed with CO2 insufflation up to 15mmHg. Indications for surgery, operative details, intraoperative complications, pathology, and postoperative complications were reviewed. We identified 123 patients (70 females [57%]) with a median age of 40years (range 16-80years) and a median BMI of 26.2kg/m2 (range 15-59kg/m2) that underwent minimally invasive thoracoscopic procedures with this technique. Procedures included: mediastinal mass resection or biopsy (41%), sympathectomy (37%), wedge resection (10%), first rib resection (6%), diaphragm plication (2%), segmentectomy (2%), decortication (2%), pleural biopsy (2%), and pericardial cyst resection (1%). Median operative time was 90min (range 25-584min) and median intraoperative blood loss was 10mL (range 2-200mL). Intraoperative hemodynamic parameters were obtained at procedure start, 1h after CO2 insufflation, and at procedure completion: we observed significant changes in heart rate and systolic blood pressure (P = 0.027 and P < 0.001, respectively) although clinically inconsequential. Mean end-tidal CO2 1h after insufflation was 36.6 ± 4.5mmHg. There were no intraoperative complications and no conversions to a DLT. Median length of stay was 1day (range 0-14days). Five complications (4%) were observed and no mortalities. SLT intubation and CO2 insufflation is a feasible and safe alternative to DLT intubation for lung isolation. This can be a useful strategy to accomplish lung isolation for some thoracoscopic procedures, in particular when expertise for DLT placement is unavailable.

The first uniportal video-assisted thoracoscopic surgery masterclass in New Zealand

Although thoracotomy is still a standard approach to lung resection for some New Zealand (NZ) surgeons, there is an increasing penetration of video-assisted thoracoscopic surgery (VATS) approaches to complex lung resection, but only a few surgeons have applied uniportal techniques. This paper describes the first uniportal VATS (uVATS) Masterclass held in NZ that includes an animal wetlab, and a 2-day live surgery with proctorship from Professor Diego Gonzalez-Rivas. In our wetlab experience, we have used single lumen endotracheal intubation and bronchial blocker to facilitate excellent lung isolation. Prof Gonzalez-Rivas proctored 6 live surgical cases of successful uVATS for lung resection without compromising the optimal oncological principles. Following this Masterclass, our unit has adopted uniportal VATS as the default approach for all lung resection and pleural based operations.

Uniportal VATS in porcine specimens using single lumen endotracheal intubation and bronchial blocker

Uniportal VATS in porcine specimens using single lumen endotracheal intubation and bronchial blocker

PS02.019: THORACOSCOPIC INTRATHORACIC ESOPHAGO-GASTRIC ANASTOMOSIS WITH PATIENT IN PRONE POSITION

Abstract Description After laparoscopic gastric conduit creation the patient is placed in prone position, with single-lumen endotracheal intubation. A right pneumothorax at 8 mmHg is created with a port at the apex of the scapula; two operative trocars are inserted in the right 5th and 9th intercostal spaces. The esophageal dissection in performed with an en bloc linfadenectomy. The distal part of the esophagus is tied up with a loop; the esophagus in then divided with an electrocautery scissor. A manual purse-string is made in the proximal esophageal stump with a Prolene 2/0. The envil of a circular stapler is put inside the chest through a port or during the laparoscopic procedure opening the right pleura; so it is introduced in the esophageal stump and the purse-string is closed. The incision of the lower port is enlarged and a laparoscopic wound retractor device is inserted. The specimen and the gastric conduit are retrieved; the stapler is introduced trough the laparoscopic wound retractor tip and through a small gastrostomy in the gastric tube; the puncturing shaft is pulled out through the greater gastric curve. We ensure the gastric conduit to the stapler with a second envil; it is introduced in the chest. After opening the stapler and loosing the second envil we perfomed the esophago-gastric anastomosis. A linear stapler is used to remove the excess of the stomach with the gastrostomy. Some interrupted stitches fixed the anastomosis to the mediastinal pleura. Two right chest tubes are inserted. Disclosure All authors have declared no conflicts of interest.

PS01.036: THORACOSCOPIC ENUCLEATION OF BENIGN LESIONS OF THE ESOPHAGUS WITH PATIENT IN PRONE POSITION

Abstract Background Benign lesions of the esophagus are rare, leiomyoma is the most common. Minimally invasive thoracoscopic enucleation is the currently best approache. We present our experience of thoracoscopic enucleation with patient in the prone position Methods Between June 2010 and December 2017 all patients referred to our Institute for symptomatic benign lesions of the esophagus underwent thoracoscopic enucleation in prone position. After single-lumen endotracheal intubation patients were placed in prone position. A right pneumothorax at 8 mmHg was created with a port at the apex of the scapula; two or three operative trocars were inserted in the right 5th and 9th intercostal spaces. The mediastinal pleura and the muscular layer over the lesion were incised and split using a coagulating hook. The lesions were carefully enucleated. The myotomy was closed with interrupted stitches. An intercostal drain was left in the right chest. Results 5 patients (3 males and 3 females) underwent thoracoscopic enucleation in prone position, without any conversion. Median operative time was 90 minutes (60–170), blood loss was minimal, there were no intraoperative or postoperative complications. 1 lesion was in the upper esophagus, 2 in the middle and 2 in the lower esophagus. The median post operative hospital stay was 9 days (9–11). Histopathology reveal 4 leiomyomas and 1 esophageal bronchogenic cyst. The median size of the lesions was 7.25 cm (3–9). In the follow up there weren’t recurrence or other symptoms. Conclusion Prone thoracoscopic enucleation of benign lesions of the esophagus is safe and feasible also for lesions &gt; 5 cm; it permits an ergonomic position and a wide, clean operative field. Double lung ventilation and less post operative pain can reduce pulmonary complications Disclosure All authors have declared no conflicts of interest.

The era of minimally invasive esophagectomy

Minimally Invasive Esophagectomy (MIE) has become a standard surgical approach for esophageal cancer in the world. In this report, we introduce the history of MIE which is different between eastern and western countries. With the development of surgical techniques, including single-lumen endotracheal intubation, CO2 artificial pneumothorax, and surgical positioning, the MIE has made great progress. It was approved that due to significantly reduced surgical trauma, MIE lowers postoperative morbidity and mortality while achieving a tumor resection efficacy comparable with the conventional open esophagectomy. The improvement of surgical instruments and modification of surgical approaches are the keys to gaining greater clinical advantage in the future of MIE, especially the popularity of robotic surgery.

Video 1 edited the main steps for closing a 3 cm tracheal fistula in a 57-year old woman after elective single-lumen endotracheal intubation for breast surgery

Video 1 edited the main steps for closing a 3 cm tracheal fistula in a 57-year old woman after elective single-lumen endotracheal intubation for breast surgery

Video 2 edited the main steps for closing a 3 cm tracheal fistula in a 71-year old man after elective single-lumen endotracheal intubation for lumbar disc surgery

Video 2 edited the main steps for closing a 3 cm tracheal fistula in a 71-year old man after elective single-lumen endotracheal intubation for lumbar disc surgery

ANESTHESIA WITH SINGLE-LUMEN ENDOTRACHEAL INTUBATION FOR THORACOSCOPIC SYMPATHECTOMY

Background: Hyperhidrosis is frenquently present in young people, caused much trouble in daily life, especially in communication. Thoracoscopic sympathectomy is an effective and safe method to treat palmar hyperhidrosis. Previously, the double - lumen tube was used. This method was too complex, expensive, accompanied pulmonary injury. We applied anesthesia with single - lumen endotracheal intubation and intrathoracic CO2 insufflation in supine position for thoracoscopic sympathectomy. The objective of this study was to evaluate the result of anesthesia and change of heart rate, arterial blood pressure, the respiration and complication. Methods: A prospective study was realized on 43 patients diagnosed palmar hyperhidrosis, and performed thoracic sympathectomy for the treatment of palmar hyperhidrosis. Patients in supine position were carried out anesthesia with the single - lumen endotracheal intubation and intrathoracic CO2 insufflation at a rate 0.5 - 1 L.min-1, sustained intrathoracic pressure at 5 - 6mmHg insufflation. All the patients were evaluated: heart rate, arterial blood pressure, saturation of peripheral oxygen (SpO­2), end-tidal carbon dioxide (EtCO2), peak airway pressure, surgery time for each lung, the complication of surgery and anesthesia, hospital stay. Results: General anesthesia with single - lumen endotracheal intubation, and intrathoracic CO2 insufflation for treating palmar hyperhidrosis was performed successfully in all patients supine position semi Fowler with the mean age 21.28 ± 5.65 (min 11 age - max 42 age), heart rate, arterial blood pressure and respiratory stability during surgery and anesthesia. SpO2 was over 98%, mean hospital stay was 2.84 ± 0.43 days (range 2- 4days). Conclusions: Anesthesia with single - lumen endotracheal intubation and intrathoracic CO2 insufflation in supine position for thoracoscopic sympathectomy was the method that provided good surgery condition, guaranteed intraoperatively heart rate, arterial blood pressure and respiratory stability. This was an effective, safe method. Key words: Single-lumen endotracheal intubation, double-lumen endotracheal tube, thoracoscopic sympathectomy