Single-lung Ventilation Research Articles

Thoracoscopy: Advances and Increasing Role for Interventional Pulmonologists.

Thoracoscopy is an increasingly common procedure that provides significant clinical information and therapeutic applications. The procedure allows the physician to biopsy the parietal pleura under direct visualization with high accuracy. In addition, one can drain pleural fluid, place a chest tube in a precise location, and perform poudrage pleurodesis. Medical thoracoscopy (MT) is carried out in the operating room or procedure suite under moderate sedation with spontaneous ventilation. In comparison, video-assisted thoracoscopic surgery (VATS) is performed under general anesthesia with single lung ventilation and through multiple ports in the operating room. MT is less invasive, has a comparable diagnostic yield, and may be better tolerated in high-risk patients. The indications, complications, and advances in thoracoscopy will be discussed in this article. In the era of rapidly evolving therapeutics for lung cancer, immune-modulation and ever-increasing risks of immunosuppression, MT will evolve and continue to play a pivotal role in the evaluation and research of pleuropulmonary diseases.

Monitorización de la variación de la presión de pulso durante la cirugía de resección pulmonar

Background and objectiveAlthough pulse pressure variation (PPV) is an effective dynamic parameter widely used to predict the increase in cardiac output after the administration of fluids in abdominal surgery, its use in thoracic surgery is controversial. A study was designed to describe the behaviour of PPV during lung resection surgery. Patients and methodsA prospective observational study was conducted on adult patients scheduled for lung resection surgery. Patients with bleeding greater than 200cc, or those who required vasopressors during data collection, were excluded. The PPV values were collected during different phases: in bipulmonary ventilation (T1), after the start of single lung ventilation, and the opening of the thorax (T2), at the end of the procedure prior to the restoration of the bipulmonary ventilation (T3), and after the closure of the thorax in bipulmonary ventilation (T4). The correlation coefficient of the PPV values at the different times was calculated. ResultsThe study included 50 consecutive patients. The mean values and standard deviations of PPV in the different phases were: T1, 11.14% (6.67); T2 6.24% (3.21, T3 5.68% (3.19), and T4 7.84% (4.61). The repeated ANOVA measurements found significant differences between the mean values of PPV in the different phases (P<.001).The correlation between the PPV values during T1 and T2 (PPVT1 and PPVT2) was r=0.868 ([P<.001], r2=0.753), while between T3 and T4 (PPVT3 and PPVT4) the correlation was r=0.616 ([P<.001], r2=0.379) between the PPV values in T3 and T4. ConclusionsPPV presents a predictable behaviour in the course of lung resection surgery, characterised by a decrease of almost half at the beginning of the unipulmonary ventilation and opening of the thorax. It then remains stable throughout the surgery when there are no changes in the intravascular blood volume.

Single-lung ventilation with bronchofibroscopy during lung resection surgery

Lung isolation using one-lung ventilation is common during thoracic surgery procedures, as it allows proper visualisation and manipulation of the lung to be operated on. Selective lobar blockade has been described in patients that do not tolerate one-lung ventilation, and is usually achieved using endobronchial blockers. However, it depends on endobronchial blocker availability, its complexity regarding proper positioning, and the need for constant monitoring to ensure the correct placement of the bronchial seal. In the clinical case to be described, a new method was used to increase the available surface for oxygen exchange. This was accomplished by means of direct supply of oxygen through the bronchoscope's working channel to one of the not-to-be operated-on, non-ventilated lung lobes. With this technique, the surgeon had an optimal operating field, oxygenation from one-lung ventilation improved and no perioperative complications were found.

Cross-sectional survey on Chinese surgeons’ practice patterns and views on video-assisted thoracoscopic surgery

Background: Surgeons’ opinions on video-assisted thoracoscopic surgery (VATS) may influence VATS adoption. This study aims to understand Chinese surgeons’ view on VATS. Methods: A questionnaire was developed to collect surgeons’ opinions on the benefits of VATS over open procedures, potential obstacles to adopt VATS, and possible indications and contraindications of VATS to treat lung cancer. Results: Ninety-six surgeons from ≥75 hospitals in ≥23 provinces completed the questionnaire. Of them, 95.8% were thoracic surgeons; 38.5%, 30.2%, and 28.1% were chief, associate chief, and attending surgeons, respectively. The chief and associate chief surgeons had significantly more years of experiences in VATS and higher monthly VATS volume than the attending surgeons (All P 75% in their practice. The top three mostly agreed (96.9–92.7%) benefits of VATS were shortening hospital stay, reducing postoperative pain, and decreasing the incidence of postoperative complications. In addition, 81% of the 96 surgeons agreed that VATS could reduce drug fee. The mostly agreed (70.8%) potential obstacle for VATS adoption was insufficient training for surgeons. The opinions on the benefit of VATS and hurdles to adopt VATS were consistent across the three professional titles. The mostly agreed indication (91.7%) and contraindication (80.2%) were stage I and II non-small cell lung cancer and inability to tolerate single lung ventilation, respectively. Conclusions: Chinese thoracic surgeons consistently agreed on clinical benefits and indications of VATS and believed insufficient training as a key obstacle to adopt VATS.

RA01.01: THORACOSCOPIC ESOPHAGECTOMY IN SEMIPRONE POSITION

Abstract Description To assess the feasibility of Thoracoscopic Esophagectomy in the Dorso-Lateral position with the intention of reducing the disadvantages and increasing the benefits of lateral approach and prone approach which are the 2 conventional approaches. Methods: Thoracoscopic Esophagectomy is routinely performed in 2 positions. The left lateral decubitus position is the commonly used position at most of the centres. However prone jack-knife position as described by Cushieri is another alternative. To combine the advantages and reduce the disadvantages of the these 2, we started performing this procedure in a Dorso-Lateral position since 1st October 2008. This is a position midway between the Lateral and Prone position i.e. Left lateral position with an inclination making an angle of 45 degrees with the horizontal. Operating Surgeon and assistant are positioned anteriorly facing the ventral aspect of the patient. A three-port approach is taken with port placements in the 5th, 7th and 9th intercostals spaces in the posterior, mid and anterior axillary lines. Pneumothorax is created with CO2 pressure of 5–7 mm Hg. Although single lung ventilation is preferable the procedure can be done with routine dual lung ventilation with a 4th port being used to retract the lung if necessary. Esophagus is mobilized en-block with posterior mediastinal lymphadenectomy. The Azygous vein and right Bronchial artery are preferably preserved to maintain vascularity of right bronchus. Following this patient is turned supine and Stomach mobilization and coeliac dissection is done laparoscopically. Left neck incision is taken and esophagus is divided in the neck. Specimen is delivered in the abdomen and extra-corporeally through a mini-laparotomy. Gastric tube is prepared and brought in the neck through posterior mediastinum underneath the azygous vein and rt.bronchial artery for anastamosis in the neck. The video shows the procedure in the Dorso-Lateral Position as we routinely perform at our centre. Conclusion: Thoracoscopic Esophagectomy with Mediastinal Lymphadenectomy in the Dorso-Lateral position is a feasible, more convenient and a safe option which can combine the benefits of the conventional left lateral and prone approaches. Surgeon comfort is enhanced in terms of more comfortable operating position and improved ergonomics. Disclosure All authors have declared no conflicts of interest.

VS02.03: LAPAROSCOPIC EXCISION OF ESOPHAGEAL FISTULA TRACT (LEEFT) IN A SPONTANEOUS ESOPHAGOCUTANEOUS FISTULA WITH KIKUCHI DISEASE

Abstract Description Spontaneous esophagocutaneous fistula is rare and necrotizing mediastinal lymphadenopathy is one of the causes. We report a case of spontaneous esophagocutaneous fistula in a 38-year-old lady with Kikuchi disease that was treated with laparoscopic excision of esophageal fistula tract (LEEFT). On endoscopy, the fistula opening was located at right posterolateral wall of distal esophagus, 3cm above esophagogastric junction. Esophageal stenting and endoscopic clipping of fistula were attempted but the fistula tract persisted. She then underwent laparoscopic excision of esophageal fistula tract. Laparoscopic excision of esophageal fistula tract (LEEFT) is a novel transhiatal technique as compared to the usual transthoracic aproach. Patient is placed in french position and it is done via 4-laparoscopic port technique with liver retraction. LEEFT is feasible in distally located esophageal fistula. In comparison to transthoracic aproach, the dissection and control of esophagus is easier with this technique as dissection through the chronic inflammatory tissue in the posterior mediastinum is avoided. Moreover, it spares the morbidity associated with single lung ventilation and transthoracic approach. Disclosure All authors have declared no conflicts of interest.

PS02.017: EFFICACY OF INTRAOPERATIVE RECURRENT LARYNGEAL NERVE MONITORING DURING UPPER MEDIASTINAL LYMPH NODE DISSECTION IN THORACOSCOPIC RADICAL ESOPHAGECTOMY

Abstract Background The development of minimally invasive surgery has yielded many benefits, therefore the number of patients undergoing thoracoscopic radical esophagectomy (TRE) for esophageal cancer has been increasing worldwide. However, in the Japanese nationwide web-based database report, the incidence of recurrent laryngeal nerve (RLN) paralysis and overall morbidity were significantly higher in the TRE group than in the open esophagectomy group. In recent years, intraoperative nerve monitoring (IONM) is commonly being used in thyroid and parathyroid surgery in many centers. We tried to determine the feasibility and effectiveness of IONM of RLN during upper mediastinal lymph node dissection in TRE. Methods All 628 patients who underwent TRE in the left lateral decubitus position at Osaka City University Hospital between May 1995 and February 2018 were enrolled in the present study. We introduced IONM using NIM® (Medtronic) during TRE from October 2016 at our hospital. We divided retrospectively the patients into two groups: IONM group (TRE with IONM of RLN; n = 49) and No-IONM group (TRE without IONM of RLN; n = 579). Diagnosis of RLN paralysis was performed using laryngoscopy. The feasibility of IONM during TRE and the incidence of postoperative RLN paralysis were compared with those in No-IONM group. Results IONM could be performed for 46 patients (93.9%) in IONM group. Three patients (6.1%) could not keep single-lung ventilation using a single lumen tracheal tube with a bronchial blocker and needed to replace a tracheal tube by a double lumen tube during TRE. The incidence of postoperative RLN paralysis (CD≧ 1; CD; Clavien-Dindo classification of surgical complications) was 17.4% in IONM group and 30.2% in No- IONM group. There was a significant difference in the incidence of postoperative RLN paralysis (P &lt; 0.05). Moreover, the right and bilateral paralysis of RLN after TRE did not occur in any patients in IONM group. Conclusion IONM of RLN during TRE is technically feasible. The introduction of standardized IONM of RLN during TRE is able to reduce the incidence of postoperative RLN paralysis. Disclosure All authors have declared no conflicts of interest.

Three-dimensional thoracoscopic vertebral body replacement at the thoracolumbar junction.

The aim is to stabilize the thoracolumbar spine with athoracoscopically implanted vertebral body replacement (VBR). To improve intraoperative depth perception and orientation, implantation is performed under three-dimensional (3D) thoracoscopic vision. Vertebral burst fractures at the thoracolumbar junction (A4AOSpine classification), pseudarthrosis, and posttraumatic instability with increasing kyphosis. Severe pulmonary dysfunctions, pulmonary or thoracic infections, previous thoracic surgery, and pulmonary adhesions. The patient is lying in aright lateral decubitus position. Localization of the fractured vertebra. Minimally invasive transthoracic approach. Perform single lung ventilation and insert the 3D thoracoscope two intercostal spaces above the working portal. Utilization of special binocular glasses for 3D vision of the operation field and secure resection of the fractured vertebra. Measurement of the bony defect and insertion of the expandable cage. Control of correct cage position under fluoroscopy. Insertion of achest tube and inflate the left lung. Chest × ray Remove chest tube when output is <500 ml/24 h Early mobilization on the ward 6weeks no weight-bearing >5 kg RESULTS: Between 2012 and 2017, 12patients received aVBR under 3D thoracoscopic vision. After amean follow up of 26months, no cage dislocation was noticed and all patients recovered from the initial back pain. Complications were notable in two cases (17%) with asmall pneumothorax after removal of the chest tube and postoperative pneumonia in one patient (8%). All responded to conservative treatment. Revision surgery was not necessary.

Staged unilateral lung volume reduction surgery: from mini-invasive to minimalist treatment strategies.

Lung volume reduction surgery (LVRS) entailing unilateral or bilateral non-anatomical resection of severely damaged emphysematous tissue carried out by thoracoscopic or open surgical approaches, under general anesthesia with single-lung ventilation, has resulted in significant and long-lasting clinical and functional benefit. Unfortunately, the morbidity rates reported by simultaneous bilateral resectional LVRS has led to raise criticism regarding its cost-effectiveness and has stimulated in recent years the development of less invasive bronchoscopic and surgical non-resectional methods of treatment that are preferentially performed in a staged unilateral fashion. We had previously proposed an innovative LVRS modality, which did not entail any resection of lung tissue and was electively carried out according to a staged unilateral strategy by a multiport thoracoscopic access, through thoracic epidural anesthesia in conscious, spontaneously ventilating patients (awake LVRS). The awake LVRS resulted in significant clinical benefit paralleling that achieved by the resectional method with lower morbidity rates and shorter hospital stay. Moreover, the awake LVRS proved also suitable to be employed in stringently selected patients to perform redo procedures following previous successful bilateral LVRS. More recently, in order to minimize the global surgery- and anesthesia-related traumas, we have modified our original non-resectional method by adopting a single thoracoscopic access as well as an anesthesia protocol entailing use of a simple intercostal block with target control sedation, to realize an ultra-minimally invasive or minimalist LVRS. Hence, a deeper investigation of the pros and cons of staged unilateral LVRS strategies as well as of the novel surgical non-resectional and redo LVRS is warranted in order to verify, the optimal strategies of treatment, which will prove to reduce the typical LVRS-related morbidity while assuring the most durable benefit in patients with advanced emphysema.

Application of protective lung ventilation model in thoracic surgery patients with single lung ventilation

Objective To explore the value of protective lung ventilation mode in patients undergoing single lung ventilation in thoracic surgery operation. Methods 59 patients undergoing surgical treatment in Ankang Central Hospital from January 2012 to January 2015 were analyzed. According to the ventilation mode adopted in the operation , the patients were divided into the protective group (30 cases) and conventional group (29 cases) . The protective group took tidal volume 8 ml/kg. According to the patient′s circulatory function, we gradually increase the end expiratory positive pressure ventilation, until 10 cmH2O. The conventional group took tidal volume 8 ml/kg and was maintained positive end expiratory pressure at 3 cmH2O. Results There was no statistically significant difference in operation time, blood volume, infusion volume, and single lung ventilation time between the protective group and the conventional group (P>0.05). There was also no statistically significant difference in T1, T2, T3, T4, inhalation of oxygen partial pressure (FiO2), mean arterial pressure (MAP) level between the two groups (P>0.05). The T2 and T3 moment of arterial oxygen partial pressure (PaO2) oxygenation index (OI) level in protective group was significantly higher than that in conventional group (P 0.05). While after the operation, the serum TNF- alpha, MIP- I, IL-8 and the level of MDA in protective group was significantly lower than that of conventional group (P<0.05), the SOD level showed the opposite (P<0.05). Conclusions The protective lung ventilation mode is beneficial to maintain the blood gas indexes, at the same time reduce the inflammatory response and protect the lung function of the patients. Key words: Thoracic surgical procedures; Pulmonary ventilation; Tidal volume; Positive-pressure respiration

Anesthesia, ventilation and pain treatment in thoracic trauma

The management of anesthesia plays acentral role in the treatment of thoracic trauma, both in the initial phase when safeguarding the difficult airway and in the intensive care unit. Arapid transfer to atrauma center should be considered in order to recognize and treat organ dysfunction in time. Development of atelectasis, pneumonia and acute lung failure are common pulmonary complications. Non-invasive ventilation combined with physiotherapy and respiratory training can help to minimize these pulmonary complications. If single lung ventilation is necessary as part of the operative patient care, adouble-lumen tube, abronchial blocker and the Univent®-Tubus (Fuji Systems Corporation, Tokyo, Japan) can be used. Special attention should be paid to the hypoxic pulmonary vasoconstriction that occurs in this maneuver. Pain therapy is ideally carried out patient-adapted with epidural anesthesia. In addition, intraoperatively inserted catheters in the sense of acontinuous intercostal block or serratus plane block are good alternatives. The aim of these therapies should be early mobilization and transfer of the patient to rehabilitation.

Laparoscopic Removal of an Ingested Foreign Body with Transesophageal Migration into the Mediastinum

Removal of a transesophageal migrated foreign body is recommended to prevent injury to adjacent structures. As the endoscopic approach is not feasible for a transesophageal foreign body migrated into the mediastinum, the thoracoscopic approach is recommended. The thoracoscopic approach often requires single lung ventilation and is associated with more pulmonary complications. The use of a laparoscopic approach to remove a mediastinal foreign body has not been reported earlier. In this report, the authors describe a laparoscopic approach for the removal of a transesophageal migrated foreign body into the lower mediastinum.

Dynamic Hyperinflation of a Giant Pulmonary Bulla on Single lung Ventilation can cause Cardiac Arrest: A Rare Case

Dynamic Hyperinflation of a Giant Pulmonary Bulla on Single lung Ventilation can cause Cardiac Arrest: A Rare Case

Radiotracer localization of nonpalpable pulmonary nodules: A single-center experience

ObjectiveMultiple localization techniques to facilitate intraoperative identification of small or nonsolid pulmonary nodules have been developed. Radiotracer localization using technetium-labeled macroaggregated albumin has been our preferred localization method since 2009. We report our experience, including technical pitfalls and modifications, of our initial 77 patients who underwent this technique. MethodsAll patients undergoing preoperative radiotracer localization were identified from a prospective database. Medical records were retrospectively reviewed for patient demographic characteristics, nodule characteristics, procedure details, pathologic data, and outcomes. ResultsSeventy-seven patients underwent localization of 79 pulmonary nodules. Radiotracer localization had an overall success rate of 95%; however, 2 patients required a second localization procedure on the same day. Most failures occurred in nodules that were < 5 mm from the pleural surface, resulting in pleural spillage. Seventy-three patients underwent a diagnostic wedge resection, with 2 of these patients requiring 2 wedge resections. In 2 patients, the nodules were successfully localized; however, they were too deep for wedge resection and required anatomic resection. Two patients did not undergo resection. One patient developed pleural spillage and hemothorax and due to subsequent comorbidities, was never rescheduled. The second patient did not tolerate single-lung ventilation. The majority (86%) of lesions were malignant. Median length of stay was 2 days (range, 1-15 days). There was no 30-day mortality. The only morbidity was a prolonged air leak (>5 days) in 5 patients. ConclusionsRadiotracer localization is a simple and effective technique for intraoperative identification of small pulmonary nodules.

Tailored management of stage IIIa non-small-cell lung cancer in the era of the 8th edition of the TNM classification for lung cancer.

Stage IIIA is a very heterogeneous group encompassing locally advanced disease with T3 and T4 tumors without any nodal involvement and very small T1a primary tumors with unilateral mediastinal lymphatic disease. Tailored management defines interdisciplinary management requiring board decisions, which can sometimes be difficult particularly in stage IIIa non-small-cell lung cancer (NSCLC). Lobectomy still is standard of care even for stage I NSCLC, which increasingly is implemented using minimally invasive surgical technique. On the other hand even locally extended tumors are today safely resected with low morbidity and mortality. According to the 2015 guidelines of the European Society of Thoracic Surgeons any kind of anatomical lung resection for lung cancer with curative intent has to be accompanied by formal mediastinal lymph node dissection. The transcervical route for complete bilateral mediastinal lymphadenectomy offers improved completeness of resection without the need for single lung ventilation and ideally supports the concept of minimally invasive surgery.

Subxiphoid Minimally Invasive Epicardial Ablation (Convergent Procedure) With Left Thoracoscopic Closure of the Left Atrial Appendage

The Convergent Procedure is a combined epicardial and endocardial ablation performed by a cardiac surgeon and electrophysiologist to treat symptomatic persistent and long standing persistent atrial fibrillation. The epicardial ablation is performed on the entire width of the posterior left atrial wall using monopolar radiofrequency via a subxiphoid incision. There is no sternotomy and cardiopulmonary bypass is not utilized. The surgical ablation is then followed by endocardial voltage mapping and ablation, allowing for complete lesion set creation. Left atrial appendage exclusion can be performed via left thoracoscopic approach at the same time as the surgical ablation. The Convergent Procedure is a truly hybrid, collaborative procedure which combines the strengths of minimally invasive cardiac surgery and percutaneous electrophysiologic techniques to treat a challenging disease process.

Effects of epidural anesthesia combined with inhalation anesthesia or intravenous anesthesia on intrapulmonary shunt and oxygenation in patients undergoing long term single lung ventilation

Objective:To investigate the effect of epidural anesthesia combined with inhalation or intravenous anesthesia on intrapulmonary shunt and oxygenation in patients undergoing long term single lung ventilation.Methods:Eighty patients, aged 35-75, American Society of Anesthesiology (ASA) classification of I-III, undergoing thoracic surgery with one lung ventilation more than three hour, were randomly divided into propofol group (group Pro), propofol combined with epidural anesthesia group (group Pro+Epi), isoflurane group (group Iso) and isoflurane combined with epidural anesthesia group (group Iso+ Epi), 20 patients in each group. Arterial blood and mixed venous blood were taken for blood gas analysis, and hemodynamic data were recorded at following time points: before induction in supine position (T1), 30min after bilateral lung ventilation (T2), 15min after one lung ventilation (T3), 30min after one lung ventilation (T4), 60min after one lung ventilation (T5), 180min after one lung ventilation (T6), intrapulmonary shunt (Qs/Qt) was calculated according to the correlation formula.Results:Qs/Qt values at T2-6 in four groups were significantly higher than that of T1, and Qs/Qt values at T3-6 was significantly higher than that of T2 (P< 0.05); PaO2 at T2-6 were significantly higher than that of T1, with PaO2 at T3-6 were significantly lower than T2 (P< 0.05). Between groups, Qs/Qt values in group Iso were significantly higher than that of group Pro, Pro+Epi and Iso+Epi at T3-5 (P< 0.05). There was no significant difference in PaO2 between groups (P> 0.05). CI at T3-6 in group Iso and Iso+Epi were significantly higher than that of T1 (P<0.05), and were significantly higher than that of propofol group (P<0.05). MAP at T3-6 in group Pro+Epi and Iso+Epi were significantly lower than that at T1 (P <0.05). Heart rate at T4-6 in group Iso were significantly higher than T1, and higher than group Pro and group Iso+Epi (P <0.05).Conclusion:One lung ventilation may predispose to increase of intrapulmonary shunt and decrease in arterial partial pressure of oxygen; isoflurane inhalation anesthesia is more likely to cause intrapulmonary shunt, but no changes in arterial partial pressure of oxygen.

Prevention of Pulmonary Edema after Minimally Invasive Cardiac Surgery with Mini-Thoracotomy Using Neutrophil Elastase Inhibitor.

Unilateral re-expansion pulmonary edema (RPE) is a rare but one of the most critical complications that may occur after re-expansion of a collapsed lung after minimally invasive cardiac surgery (MICS) with mini-thoracotomy. We performed a total of 40 consecutive patients with MICS by right mini-thoracotomy with single-lung ventilation between January 2013 and June 2016. We divided the patients into control group (n = 13) and neutrophil elastase inhibitor group (n = 27). Neutrophil elastase inhibitor group received continuous intravenous infusion of neutrophil elastase inhibitor at 0.2-0.25 mg/kg per hour from the start of anesthesia until extubation during the perioperative period. There were no relations with operative time, cardiopulmonary bypass (CPB) time, aortic clamp time, and intraoperative water valances for postoperative mechanical ventilation support time. Compared with the neutrophil elastase inhibitor group, the control group had significantly higher initial alveolar-arterial oxygen gradient and significantly lower initial ratio of partial pressure of arterial oxygen to fraction of inspired oxygen at the intensive care unit (ICU). The control group had significantly longer postoperative mechanical ventilation support time and hospital stay compared with the neutrophil elastase inhibitor group. Neutrophil elastase inhibitor may have beneficial effects against RPE after MICS with mini-thoracotomy.

Thoracoscopic Rib Resection in Children.

The authors present a multicenter retrospective series of different benign rib lesions in children operated on using thoracoscopy. Between 2005 and 2015, 17 rib resections were performed thoracoscopically, in four French departments of pediatric surgery. Of these 17 cases, 13 exostoses, 2 endochondromas, 1 synostosis, and 1 Cyriax's syndrome were noted. Inclusion criteria were benign tumors or rib anomalies such as synostosis, in children younger than the age of 18 years, and thoracoscopy. Open surgery and malignant tumors were excluded. Thoracoscopy was put forward using one optical port as well as one or two operative ports. Ten patients presented with chest pain, dyspnea, or unexplained cough. Six tumors were incidentally diagnosed. One patient presented with a chest wall deformation. Single-lung ventilation was required in 2 cases. In 1 case of endochondroma, a segmental rib resection was performed, leaving a part of the periosteum and the intercostal vessels and nerve. In this case, rib resection was performed using an endoscopic shaver drill system. As for the other cases, a simple resection of the tumor or of the bridge between two ribs (synostosis) was performed. In these cases, a Codman Kerrison laminectomy rongeur was used. There was no complication during or after surgery. Nevertheless, 2 years after surgery, pain did not disappear in 1 case, probably due to a definitive intercostal nerve damage. Benign rib lesions in children are rare. Thoracoscopy may be offered to reduce the functional deleterious consequences of an open surgery. It may be put forward especially in case of hereditary multiple exostoses where redo procedures may be required.

Application of self-made extended endobronchial tube in thoracoscopic surgery for esophageal cancer

Objective To observe the feasibility and safety of self-made extended endobronchial tube applicated in one-lung ventilation for radical resection of esophageal cancer. Methods 80 patients were randomly divided into two groups: self-made extended endobronchial tube group (group A) and double-lumen endobronchial tube group (group B). The degree of lung collapse, systolic blood pressure, diastolic blood pressure, heart rate, airway pressure (Paw), arterial partial pressure of oxygen(PaO2), arterial partial pressure of carbon dioxide(PaCO2), arterial oxygen saturation (SaO2) were monitored.The time for insertion, rate of successfully intubation for single time, incidence of postoperative hoarseness and sore throat were recorded. Results There were no significant differences in degree of lung collapse, systolic blood pressure, diastolic blood pressure and heart rate, SaO2 in the two groups(all P>0.05). The comparison of the time for insertion between the two groups: (1.5±0.4)min vs.(2.6±0.8)min(t=4.78, P<0.05); rates of successfully intubation for single time: 95.0% vs.80.0%(χ2=5.19, P<0.05). The comparison of Paw between the two groups: T1: (17.3±1.1)cmH2O vs.(22.5±0.9)cmH2O, t=4.613, P<0.05; T2: (17.9±0.5)cmH2O vs.(23.6±1.4)cmH2O(t=5.438, P<0.05); T3: (18.1±0.8)cmH2O vs.(24.6±1.2)cmH2O(t=3.741, P<0.05). The comparison of blood gas during one-lung ventilation between the two groups: PaO2(281.5±53.4)mmHg vs.(187.6±48.8)mmHg(t=5.28, P<0.05); SaO2(98.1±6.3)% vs.(94.5±5.7)%(t=3.46, P<0.05); PaCO2(31.2±3.6)mmHg vs.(37.6±4.1)mmHg(t=6.32, P<0.05). The comparison of incidence of postoperative hoarseness: 1case vs.6cases(χ2=5.91, P<0.05); The comparison of incidence of sore throat: 4cases vs.13cases(χ2=6.13, P<0.05). Conclusion Single-lung ventilation has achieved via either the double lumen tube or the self-made extended endobronchial tube.However, the self-made extended endobronchial tube is recommended for single-lung ventilation because of the advantages of its easy intubation and position, full oxygenation, low Paw, less incidence of postoperative hoarseness and sore throat.Self-made extended endobronchial tube can be used as a one-lung ventilation method in its indications. Key words: Esophageal neoplasms; Esophagectomy; Thoracoscopy