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Jinyu H, Kaiyuan W, Zhun W, Hui Y, Xiaofeng D. Comparison of CO 2 artificial pneumothoraces and bronchial blockers in lymphadenectomy along the left recurrent laryngeal nerve during robot-assisted esophagectomy. Surg Endosc 2025; 39:2534-2539. [PMID: 40032664 DOI: 10.1007/s00464-025-11641-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Accepted: 02/21/2025] [Indexed: 03/05/2025]
Abstract
BACKGROUND To analyze the effects of different intubation and ventilation modes on left recurrent laryngeal nerve lymph node dissection and postoperative complications in patients undergoing robotic-assisted minimally invasive esophagectomy (RAMIE). METHODS Overall, 339 patients with esophageal cancer who underwent RAMIE at Tianjin Medical University Cancer Hospital between June 2017 and December 2021 were selected for this retrospective study. The effects of CO2 artificial pneumothorax and bronchial blockers on the number of lymph nodes dissected and the incidence of postoperative complications were compared. RESULTS Among 339 patients, 111 underwent surgery using CO2 artificial pneumothorax, while 228 used bronchial occlusion devices. There were no significant differences in baseline characteristics between the two groups (p > 0.05). The total number of lymph nodes dissected (31.11 ± 13.00 vs. 24.42 ± 11.10, p < 0.001), the number of thoracic lymph nodes dissected (19.53 ± 9.80 vs. 15.00 ± 7.85, p < 0.001), and the number of lymph nodes dissected around the left recurrent laryngeal nerve (3.62 ± 3.19 vs. 2.72 ± 3.18, p = 0.015) were significantly higher in the bronchial occlusion group than in compared to the CO2 pneumothorax ventilation group. There were no significant differences in the number of right recurrent laryngeal lymph node dissection between the two groups (3.15 ± 2.89 vs. 2.68 ± 2.25, p = 0.132). The incidence of recurrent laryngeal nerve injury was significantly lower in the bronchoclusive single-lung ventilation group than in the CO2 artificial pneumothorax group (15 [6.57%] vs. 17 [15.31%], p = 0.010). There were no significant differences in the incidence of overall postoperative complications, including pulmonary complications, anastomotic fistula, chylothorax, incision infection, or cardiovascular complications (all p > 0.05). However, a significant difference was noted in the Clavien-Dindo grading of postoperative complications (p = 0.016) and the number of days of hospitalization between the two groups (17.93 ± 9.98 vs. 14.48 ± 10.45, p = 0.004). CONCLUSIONS The bronchial blocker, one-lung ventilation mode was found to be more advantageous in lymphadenectomies than the CO2 artificial pneumothorax, two-lung ventilation mode, given the reduced occurrence of related complications and length of hospitalization.
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Affiliation(s)
- Han Jinyu
- Department of Anesthesiology, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, 300060, China
| | - Wang Kaiyuan
- Department of Anesthesiology, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, 300060, China
| | - Wang Zhun
- Department of Anesthesiology, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, 300060, China
| | - Yue Hui
- Department of Anesthesiology, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, 300060, China
| | - Duan Xiaofeng
- Department of Esophageal Surgery, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, 300060, China.
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Cauti FM, Capone S, Rossi P, Polselli M, Venuta F, Vannucci J, Bruno K, Pugliese F, Tozzi P, Bianchi S, Anile M. Cardiac sympathetic denervation for untreatable ventricular tachycardia in structural heart disease. Strengths and pitfalls of evolving surgical techniques. J Interv Card Electrophysiol 2025; 68:381-389. [PMID: 36282370 DOI: 10.1007/s10840-022-01404-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/19/2022] [Indexed: 10/31/2022]
Abstract
Cardiac sympathetic denervation (CSD) is a valuable option in the setting of refractory ventricular arrhythmias in patient with structural heart disease. Since the procedure was introduced for non structural heart disease patients the techniques evolved and were modified to be adopted in several settings. In this state-of-the-art article we revised different techniques, their rationale, strengths, and pitfalls.
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Affiliation(s)
- Filippo Maria Cauti
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebenefratelli Isola Tiberina, Via Ponte Quattro Capi 39, 00186, Rome, Italy.
| | - Silvia Capone
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebenefratelli Isola Tiberina, Via Ponte Quattro Capi 39, 00186, Rome, Italy
- Cardiology Unit, Dipartimento Cuore E Grossi Vasi, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Pietro Rossi
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebenefratelli Isola Tiberina, Via Ponte Quattro Capi 39, 00186, Rome, Italy
| | - Marco Polselli
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebenefratelli Isola Tiberina, Via Ponte Quattro Capi 39, 00186, Rome, Italy
| | - Federico Venuta
- Thoracic Unit, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Jacopo Vannucci
- Thoracic Unit, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Katia Bruno
- Department of Anesthesiology, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Francesco Pugliese
- Department of Anesthesiology, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Pierfrancesco Tozzi
- Department of Anesthesiology, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Stefano Bianchi
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebenefratelli Isola Tiberina, Via Ponte Quattro Capi 39, 00186, Rome, Italy
| | - Marco Anile
- Thoracic Unit, Policlinico Umberto I, Sapienza University, Rome, Italy
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Li X, Yu L, Yang J, Fu M, Tan H. Comparison of early postoperative pulmonary complications between two-lung ventilation with artificial pneumothorax and one-lung ventilation with bronchial blockade in patients undergoing minimally invasive esophagectomy: a retrospective propensity score-matched cohort study. J Thorac Dis 2024; 16:1777-1786. [PMID: 38617773 PMCID: PMC11009580 DOI: 10.21037/jtd-23-1667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/18/2024] [Indexed: 04/16/2024]
Abstract
Background Two-lung ventilation (TLV) with artificial carbon dioxide (CO2) pneumothorax is used during the thoracoscopic phase of minimally invasive esophagectomy (MIE). However, the impact of TLV with artificial pneumothorax on postoperative pulmonary complications (PPCs) after MIE is unclear. This study aimed to compare the incidence of early PPCs between TLV with CO2 pneumothorax and one-lung ventilation (OLV) with bronchial blockade in patients undergoing MIE. Methods Five hundred ninety-three patients with esophageal cancer who underwent elective MIE with two-field lymph node dissection were analyzed. Patients in the TLV group were intubated using a single-lumen endotracheal tube and underwent surgery using TLV with artificial CO2 pneumothorax. Patients in the OLV group underwent surgery using OLV with a bronchial blocker. Patient characteristics and intraoperative and PPC data were collected and analyzed. Propensity score matching (PSM) was performed to reduce confounding bias. Results The TLV and OLV group comprised 513 and 80 patients, respectively. PSM matched 197 TLV group and 73 OLV group patients. Incidence of pneumonia within the first 3 days of surgery was higher in the TLV group (11.7% vs. 4.1%) but the difference was not significant (P=0.06). The incidence of infiltrates on chest radiography was 36.0% in the TLV group and 28.8% in the OLV group (P=0.26). Incidence of other major PPCs requiring treatment and major non-pulmonary postoperative complications did not significantly differ between the groups. Length of hospital stay was significantly longer in the TLV group (13.0 vs. 11.0 days; P=0.03). Conclusions Compared with OLV with bronchial blockade, TLV with CO2 pneumothorax did not reduce the incidence of early PPCs after MIE.
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Affiliation(s)
- Xiaoxi Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ling Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jiaonan Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Miao Fu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hongyu Tan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, China
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Suzuki T, Ishibashi Y, Tsujimoto H, Sugasawa H, Wakamatsu K, Kouzu K, Itazaki Y, Sugihara T, Harada M, Ito N, Kishi Y, Ueno H. Clinical significance of postoperative subcutaneous emphysema after video-assisted thoracoscopic surgery for esophageal cancer. Surg Endosc 2023; 37:2014-2020. [PMID: 36284014 DOI: 10.1007/s00464-022-09730-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 10/11/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Postoperative subcutaneous emphysema (SE) is a possible complication of thoracoscopic or laparoscopic surgery. This study investigated the risk factors and clinical significance of SE after video-assisted thoracoscopic surgery for esophageal cancer (VATS-e). METHODS This study included 135 patients who underwent VATS-e with artificial CO2 pneumothorax. Based on the X-ray images on the first postoperative day, patients were divided into two groups: N/L group (no SE or SE localized at the thoracic area, n = 65) and SE group (SE extended to the cervical area, n = 70). We compared clinicopathological features, surgical findings, and short-term outcomes between the two groups. RESULTS In SE group, there were more patients who received neoadjuvant chemotherapy compared to N/L group. SE group had significantly lower preoperative body mass index. SE group had more frequently two-lung ventilation than N/L group. Multivariate analysis demonstrated that low BMI, NAC, and two-lung ventilation were independent risk factors for SE extended to the cervical area. Although pulmonary complication was relatively frequent in SE group, there were no significant differences in surgical outcomes between two groups, and all patients had SE disappeared within 21 days without serious complications. CONCLUSIONS Despite extension to the cervical area, SE had a modest impact on the short-term result of VATS-e with artificial CO2 pneumothorax.
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Affiliation(s)
- Takafumi Suzuki
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Yusuke Ishibashi
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Hironori Tsujimoto
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan.
| | - Hidekazu Sugasawa
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Kotaro Wakamatsu
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Keita Kouzu
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Yujiro Itazaki
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Takao Sugihara
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Manabu Harada
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Nozomi Ito
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Yoji Kishi
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
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Yao W, Li M, Zhang C, Luo A. Recent Advances in Videolaryngoscopy for One-Lung Ventilation in Thoracic Anesthesia: A Narrative Review. Front Med (Lausanne) 2022; 9:822646. [PMID: 35770016 PMCID: PMC9235869 DOI: 10.3389/fmed.2022.822646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
Since their advent, videolaryngoscopes have played an important role in various types of airway management. Lung isolation techniques are often required for thoracic surgery to achieve one-lung ventilation with a double-lumen tube (DLT) or bronchial blocker (BB). In the case of difficult airways, one-lung ventilation is extremely challenging. The purpose of this review is to identify the roles of videolaryngoscopes in thoracic airway management, including normal and difficult airways. Extensive literature related to videolaryngoscopy and one-lung ventilation was analyzed. We summarized videolaryngoscope-guided DLT intubation techniques and discussed the roles of videolaryngoscopy in DLT intubation in normal airways by comparison with direct laryngoscopy. The different types of videolaryngoscopes for DLT intubation are also compared. In addition, we highlighted several strategies to achieve one-lung ventilation in difficult airways using videolaryngoscopes. A non-channeled or channeled videolaryngoscope is suitable for DLT intubation. It can improve glottis exposure and increase the success rate at the first attempt, but it has no advantage in saving intubation time and increases the incidence of DLT mispositioning. Thus, it is not considered as the first choice for patients with anticipated normal airways. Current evidence did not indicate the superiority of any videolaryngoscope to another for DLT intubation. The choice of videolaryngoscope is based on individual experience, preference, and availability. For patients with difficult airways, videolaryngoscope-guided DLT intubation is a primary and effective method. In case of failure, videolaryngoscope-guided single-lumen tube (SLT) intubation can often be achieved or combined with the aid of fibreoptic bronchoscopy. Placement of a DLT over an airway exchange catheter, inserting a BB via an SLT, or capnothorax can be selected for lung isolation.
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Ren Y, Zhu X, Yan H, Chen L, Mao Q. Cardiorespiratory impact of intrathoracic pressure overshoot during artificial carbon dioxide pneumothorax: a randomized controlled study. BMC Anesthesiol 2022; 22:76. [PMID: 35321653 PMCID: PMC8941761 DOI: 10.1186/s12871-022-01621-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 03/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study is to evaluate cardiovascular and respiratory effects of intrathoracic pressure overshoot (higher than insufflation pressure) in patients who underwent thoracoscopic esophagectomy procedures with carbon dioxide (CO2) pneumothorax. METHODS This prospective research included 200 patients who were scheduled for esophagectomy from August 2016 to July 2020. The patients were randomly divided into the Stryker insufflator (STR) group and the Storz insufflator (STO) group. We recorded the changes of intrathoracic pressure, peak airway pressure, blood pressure, heart rate and central venous pressure (CVP) during artificial pneumothorax. The differences in blood gas analysis, the administration of vasopressors and the recovery time were compared between the two groups. RESULTS We found that during the artificial pneumothorax, intrathoracic pressure overshoot occurred in both the STR group (8.9 mmHg, 38 times per hour) and the STO group (9.8 mmHg, 32 times per hour). The recorded maximum intrathoracic pressures were up to 58 mmHg in the STR group and 51 mmHg in the STO group. The average duration of intrathoracic pressure overshoot was significantly longer in the STR group (5.3 ± 0.86 s) vs. the STO group (1.2 ± 0.31 s, P < 0.01). During intrathoracic pressure overshoot, a greater reduction in systolic blood pressure (SBP) (5.6 mmHg vs. 1.1 mmHg, P < 0.01), a higher elevation in airway peak pressure (4.8 ± 1.17 cmH2O vs. 0.9 ± 0.41 cmH2O, P < 0.01), and a larger increase in CVP (8.2 ± 2.86 cmH2O vs. 4.9 ± 2.35 cmH2O, P < 0.01) were observed in the STR group than in the STO group. Vasopressors were also applied more frequently in the STR group than in the STO group (68% vs. 43%, P < 0.01). The reduction of SBP caused by thoracic pressure overshoot was significantly correlated with the duration of overshoot (R = 0.76). No obvious correlation was found between the SBP reduction and the maximum pressure overshoot. CONCLUSIONS Intrathoracic pressure overshoot can occur during thoracoscopic surgery with artificial CO2 pneumothorax and may lead to cardiovascular adverse effects which highly depends on the duration of the pressure overshoot. TRIAL REGISTRATION Clinicaltrials.gov ( NCT02330536 ; December 24, 2014).
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Affiliation(s)
- Yunqin Ren
- Department of Anesthesiology, Daping Hospital, Army Medical University, 10 ChangjiangZhilu, Yuzhong District, 400042, Chongqing, China
| | - Xing Zhu
- Department of Anesthesiology, Daping Hospital, Army Medical University, 10 ChangjiangZhilu, Yuzhong District, 400042, Chongqing, China
| | - Hong Yan
- Department of Anesthesiology, Daping Hospital, Army Medical University, 10 ChangjiangZhilu, Yuzhong District, 400042, Chongqing, China
| | - Liyong Chen
- Department of Anesthesiology, Daping Hospital, Army Medical University, 10 ChangjiangZhilu, Yuzhong District, 400042, Chongqing, China
| | - Qingxiang Mao
- Department of Anesthesiology, Daping Hospital, Army Medical University, 10 ChangjiangZhilu, Yuzhong District, 400042, Chongqing, China.
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Li L, Zhao L, He J, Han Z. Application of Right Bronchial Occlusion under Artificial Pneumothorax in the Thoracic Phase of Minimally Invasive McKeown Esophagectomy. Ann Thorac Cardiovasc Surg 2021; 27:339-345. [PMID: 34321388 PMCID: PMC8684836 DOI: 10.5761/atcs.oa.21-00055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Li Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, CAMS & PUMC, Beijing, China
| | - Luo Zhao
- Department of Thoracic Surgery, Peking Union Medical College Hospital, CAMS & PUMC, Beijing, China
| | - Jia He
- Department of Thoracic Surgery, Peking Union Medical College Hospital, CAMS & PUMC, Beijing, China
| | - Zhijun Han
- Department of Thoracic Surgery, Peking Union Medical College Hospital, CAMS & PUMC, Beijing, China
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Chuang KH, Lai HH, Chen Y, Chen LC, Lu HI, Chen YH, Li SH, Lo CM. Improvement of surgical complications using single-lumen endotracheal tube intubation and artificial carbon dioxide pneumothorax in esophagectomy: a meta-analysis. J Cardiothorac Surg 2021; 16:100. [PMID: 33882958 PMCID: PMC8059030 DOI: 10.1186/s13019-021-01459-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 04/05/2021] [Indexed: 12/29/2022] Open
Abstract
Background Esophageal cancer has a poor prognosis. Surgery is the main treatment but involves a high risk of complications. Some surgical strategies have tried to eliminate complications. Our meta-analysis tried to find the benefits of single-lumen endotracheal tube intubation with carbon dioxide (CO2) inflation. Methods A systematic search of studies on esophagectomy and CO2 inflation was conducted using PubMed, Medline, and Scopus. The odds ratio of post-operative pulmonary complications and anastomosis leakage were the primary outcomes. The standardized mean difference (SMD) in post-operative hospitalization duration was the secondary outcome. Results The meta-analysis included four case-control studies with a total of 1503 patients. The analysis showed a lower odds ratio of pulmonary complications in the single-lumen endotracheal tube intubation in the CO2 inflation group (odds ratio: 0.756 [95% confidence interval, CI: 0.518 to 1.103]) compared to that in the double-lumen endotracheal tube intubation group, but anastomosis leakage did not improve (odds ratio: 1.056 [95% CI: 0.769 to 1.45])). The SMD in hospitalization duration did not show significant improvement. (SMD: -0.141[95% CI: − 0.248 to − 0.034]). Conclusions Single-lumen endotracheal tube intubation with CO2 inflation improved pulmonary complications and shortened the hospitalization duration. However, no benefit in anastomosis leakage was observed.
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Affiliation(s)
- Kai-Hao Chuang
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niaosung Dist., Kaohsiung, Taiwan, Republic of China
| | - Hsing-Hua Lai
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niaosung Dist., Kaohsiung, Taiwan, Republic of China
| | - Yu Chen
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niaosung Dist., Kaohsiung, Taiwan, Republic of China
| | - Li-Chun Chen
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niaosung Dist., Kaohsiung, Taiwan, Republic of China
| | - Hung-I Lu
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niaosung Dist., Kaohsiung, Taiwan, Republic of China
| | - Yen-Hao Chen
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shau-Hsuan Li
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Ming Lo
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niaosung Dist., Kaohsiung, Taiwan, Republic of China.
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Chao YK, Tsai CY, Illias AM, Chen CY, Chiu CH, Chuang WY. A standardized procedure for upper mediastinal lymph node dissection improves the safety and efficacy of robotic McKeown oesophagectomy. Int J Med Robot 2021; 17:e2244. [PMID: 33591632 DOI: 10.1002/rcs.2244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Recurrent laryngeal nerve (RLN) palsy is a common complication of upper mediastinal lymph node dissection (UMLND) in the context of oesophageal cancer surgery. In an effort to reduce its occurrence, we developed a standardised surgical procedure that allows flexible suspension of the left RLN during robotic McKeown oesophagectomy. PATIENTS AND METHODS Patients who received robotic McKeown oesophagectomy for cancer were divided into two groups (pre and poststandardisation). Perioperative outcomes were retrospectively compared. RESULTS The pre and poststandardisation groups consisted of 44 and 42 patients, respectively. There were no significant intergroup differences in terms of number of dissected lymph nodes. Compared with the prestandardisation group, patients treated after standardisation had a markedly lowered incidence of left RLN palsy (20.5% vs. 4.8%, respectively, p = 0.029) and a reduced mean thoracic operating time (161.05 vs. 131 min, respectively, p < 0.001). CONCLUSION Our standardised surgical approach is efficient and may increase the safety of UMLND.
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Affiliation(s)
- Yin-Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Yi Tsai
- Department of General Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Amina M Illias
- Department of Anesthesiology, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Yu Chen
- Department of Anesthesiology, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Hung Chiu
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Yu Chuang
- Department of Pathology, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan, Taiwan
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10
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Thammineedi SR, Patnaik SC, Nusrath S. Minimal Invasive Esophagectomy-a New Dawn of EsophagealSurgery. Indian J Surg Oncol 2020; 11:615-624. [PMID: 33299280 PMCID: PMC7714894 DOI: 10.1007/s13193-020-01191-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022] Open
Abstract
Surgery is the mainstay of esophageal cancer. However, esophagectomy is a major surgical trauma on a patient with high morbidity and mortality. The intent of minimally invasive esophagectomy (MIE) is to decrease the degree of surgical trauma and perioperative morbidity associated with open surgery, and provide faster recovery and shorter hospital stay with the equivalent oncological outcome. It also allows for lesser pulmonary morbidity, less blood loss, less pain, and a better quality of life. MIE is safe and effective but has a steep learning curve with high technical expertise. Recently, it is increasingly accepted and adopted all over the globe. In this article, we discuss the safety, efficacy, short-term, and oncological outcomes of thoracoscopic- and laparoscopic-assisted minimally invasive esophagectomy and robotic surgery compared with open esophagectomy with a special focus on the Indian perspective.
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Affiliation(s)
| | - Sujit Chyau Patnaik
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
| | - Syed Nusrath
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
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Lu Y, Zhang R. Analysis of the learning curve for artificial pneumothorax during an endoscopic McKeown-type resection of oesophageal carcinoma. Transl Cancer Res 2020; 9:5949-5955. [PMID: 35117207 PMCID: PMC8797677 DOI: 10.21037/tcr-19-2813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 08/20/2020] [Indexed: 11/06/2022]
Abstract
Background Due to the large trauma caused by conventional open surgery, minimally invasive esophageal cancer surgery has been gradually carried out, and there is no report on the learning curve for artificial pneumothorax during an endoscopic McKeown-type resection of oesophageal carcinoma. Methods Forty cases of McKeown resection of oesophageal carcinoma with artificial pneumothorax that were completed by the same operator between December 2017 and August 2019 were analysed. The patients were divided into four groups (A, B, C, D) of 10 cases each according to the order of operation. The operation time, intraoperative blood loss, total lymph nodes and left recurrent laryngeal nerve lymph nodes resection, conversion rate, complication rate and hospitalization time were compared between the four groups. Results The operation time of the four groups were as follows: A, 243.2±44.1 min; B, 265.0±59.3 min; C, 255.8±41.7 min; D, 201.0±16.2 min, there were significant difference in terms of the operation time between group A, group B, group C and group D (P<0.05). Moreover, groups A and C all differed significantly from group D in the number of dissected left recurrent laryngeal nerve lymph nodes. However, no significant inter-group differences were observed in the number of trans-laparotomy and trans-thoracotomy, number of dissected total lymph nodes, intraoperative blood loss, incidence of postoperative complications and postoperative length of hospital stay (P>0.05). Conclusions Artificial pneumothorax during an endoscopic McKeown-type resection of oesophageal carcinoma required a learning curve of approximately 30 cases.
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Affiliation(s)
- Yanhong Lu
- Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Cancer Hospital), Hefei, China
| | - Rongxin Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Cancer Hospital), Hefei, China
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Perfusion speed of indocyanine green in the stomach before tubulization is an objective and useful parameter to evaluate gastric microcirculation during Ivor-Lewis esophagectomy. Surg Endosc 2020; 34:5649-5659. [PMID: 32856151 DOI: 10.1007/s00464-020-07924-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Anastomotic leakage (AL) during Ivor-Lewis esophagectomy (ILE), owing to gastric conduit (GC) ischemia, is a serious complication. Measurement parameters during intraoperative ICG fluorescence angiography (ICG-FA) are unclear. We aimed to identify objective ICG-FA parameters associated with AL. STUDY DESIGN Patients > 18 years with an indication for ILE were enrolled. ICG-FA was performed at the abdominal and thoracic stage, and data, such as time of fluorescence appearance, speed of ICG perfusion, quality of GC perfusion (good, poor, ischemic), blood pressure, baseline patient characteristics, GC dimensions, and other intraoperative parameters were collected. On postoperative day 4 to 6, Gastrografin swallow radiography was performed. AL development was classified based on the Clavien-Dindo and SISG severity classifications. Univariate analysis with a 95% confidence level (p < 0.05) was performed. Factors with p < 0.05 were included in the multivariate analysis. RESULTS 100 patients were enrolled. During ICG-FA, evaluation of subjective perfusion was a very specific test (94.1%) with good negative predictive value (NPV 71.9%, p 0.034), but not powerful enough to detect patients at risk of leak (sensibility 21.8%, PPV 63.6%). The GC perfusion speed (cm/s) after gastric vascular isolation and before tubulization showed a significant association with AL (p < 0.003). Median arterial blood pressure in the thoracic stage (p < 0.001) or use of inotropic (p < 0.033) was associated with AL development. CONCLUSION GC perfusion speed at ICG-FA is an objective parameter that could predict AL risk. Other results emphasize the importance of the microcirculation in the development of AL.
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Zhao F, Wang Z, Ye C, Liu J. Effect of Transcutaneous Electrical Acupoint Stimulation on One-Lung Ventilation-Induced Lung Injury in Patients Undergoing Esophageal Cancer Operation. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:9018701. [PMID: 32595749 PMCID: PMC7298312 DOI: 10.1155/2020/9018701] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/04/2020] [Accepted: 03/16/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate the effect of transcutaneous electrical acupoint stimulation (TEAS) on one-lung ventilation-induced injury in patients undergoing esophageal cancer operation. METHODS The participants (n = 121) were randomly assigned into TEAS and sham groups. The TEAS group was given transcutaneous electrical stimulation therapy. The acupoints selected were Feishu (BL13), Hegu (L14), and Zusanli (ST36) and were treated 30 minutes before induction of anesthesia; treatment lasts 30 minutes. The sham group was connected to the electrode on the same acupoints, but electronic stimulation was not applied. The levels of oxygenation index (PaO2/FiO2) and alveolar-arterial oxygen tension difference (A-aDO2) before one-lung ventilation (T1), 30 minutes after one-lung ventilation (T2), 2 hours after one-lung ventilation (T3), and 1 hour after the operation (T4) and the levels of serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) at T1, T2, T3, and 24 hours after the operation (T5) were taken as the primary endpoints. The incidence of postoperative pulmonary complications, removal time of thoracic drainage tube, and length of hospital stay were taken as the secondary endpoints. RESULTS Compared with that, in the sham group, the level of PaO2/FiO2 in the TEAS group was significantly increased at T2, T3, and T4, and the level of A-aDO2 was significantly reduced at T2 and T3 (P < 0.05). Besides, compared with that, in the sham group, the level of serum TNF-α at T2, T3, and T5, as well as the level of serum IL-6 at T3 and T5, was significantly reduced, whereas the level of serum IL-10 at T3 was significantly increased (P < 0.05). The incidences of pulmonary infection and pleural effusion in the TEAS group were significantly lower than that in the sham group, and the removal time of thoracic drainage tube and the length of hospital stay in the TEAS group were significantly shorter than that in the sham group (P < 0.05). CONCLUSIONS TEAS could effectively increase the levels of PaO2/FiO2 and IL-10, reduce the levels of A-aDO2, TNF-α, and IL-6, and reduce the incidence of pulmonary complications. Moreover, it could also contribute to shorten the removal time of thoracic drainage tube and the length of hospital stay.
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Affiliation(s)
- Fangchao Zhao
- Department of Thoracic Surgery, Tangshan People's Hospital, North China University of Science and Technology, Tangshan 063000, China
| | - Zengying Wang
- Department of Clinical Medicine, North China University of Science and Technology, Tangshan 063000, China
| | - Chengyuan Ye
- Department of Cancer Comprehensive Therapy, Tangshan People's Hospital, North China University of Science and Technology, Tangshan 063000, China
| | - Jianming Liu
- Department of Thoracic Surgery, Tangshan People's Hospital, North China University of Science and Technology, Tangshan 063000, China
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