One-lung ventilation in the thoracic surgical patient can be achieved with the use of a double-lumen endotracheal tube (DLT). But it has the defect of interference of the surgical field under uniportal VATS and needs an additional incision. Thoracoscopic surgeries involving the carina pose more challenges to the anesthesiologists, as it requires precise airway management to maintain sufficient airflow in the distal airways.Ĭross-field intubation was traditionally used in the carinal resection and reconstruction surgeries ( 2). The thoracic surgeries by uniportal VATS approach necessitate lung isolation and one-lung ventilation (OLV) to enhance the surgical view and provide adequate operating space. Uniportal video-assisted thoracic surgery (VATS) is a minimally invasive procedure that has many potential advantages, including less postoperative pain, faster recovery and a better cosmetic incision ( 1). Keywords: Case report carinal resection double-lumen endotracheal tube uniportal video-assisted thoracic surgery (VATS) We suggest that the double lumen tube could be modified being a simple and safe option for one-lung ventilation in carinal resection and reconstruction under uniportal VATS.
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A modified double-lumen tube (DLT) was inserted to achieve one-lung ventilation, and high-frequency jet ventilation (HFJV) was passed through the DLT to provide oxygenation during the anastomosis without interfering with the surgical procedure. Right upper sleeve lobectomy, carinal resection and reconstruction was performed under uniportal VATS. The case we present was a 58-year-old female with carcinoma in the right upper lobe involving the right main bronchus and the lower trachea. The ventilation techniques require maintaining adequate gas exchange while providing a good surgical exposure.
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Abstract: For bronchial sleeve and carinal resection and reconstruction during uniportal video-assisted thoracic surgery (VATS), ventilation technique remains a demanding challenge for the anesthesiologists.