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OBJECTIVE: Prone position Thoracoscopy with Modified DLV (MDLV) and conservative ventilation strategies is more physiological with no compromise to surgical technique or patient safety during Minimally Invasive Oesophagectomy (MIO).
AIM:To analyse and measure the outcome in terms of 1) Modification in default ventilator settings, 2) Hemodynamic Instability and 3) Change in surgical strategy.
METHODS: In this observational study of 46 consecutive patients who underwent Prone position Thoracoscopy as a part of MIO with MODIFIED DUAL LUNG VENTILATION using a single lumen portex endotracheal tube.Conservative respiratory settings (FiO2 - 40%, No PEEP, Tidal volume - 6ml) formed the default with Co2 insuflation pressure at 8mmHg.Respiratory parameters, hemodynamic and surgical variables were monitored at 0,15, 30 and every 30 minutes thereafter until completion.
RESULTS: All patients were evaluated on various variables mainly the O2 Saturation,PO2,PH,Pco2,Haemodynamic parameters and need for the change in default ventilator settings.O2 saturation and PO2 are mentioned as per table at various intervels.100% o2 and PEEP 5 applied in 16 patients predominantly following air entry into contralateral lung.3 patients had hypercarbia with haemodynamic compromise needed increase in minute ventilation.Hypotension was present in 24 patients which was treated with fluids and intermittent doses of ephedrine and no inotrope support was needed in any. 29 patients had Hypertension (9 pt received nitroglycerin infusion). Bradycardia noted in 14 patients predominently following thoracic epidural ,treated with IV atropine.Tachycardia was present in 7 patients required IV betablockers. Intraoperative arrhythmias needing correction was noted in 2 patients.Surgery was temporarily stopped in 3patients (2 had ARRHYTHMIAS AND 1 had tension pneumothorax).Change in surgical strategy noted in 1 patient where, because of persistant hypoxia instead of ivor luis precedure cervical anastomosis was done. Fan shaped retractor was used in 3pt to collapse lung
CONCLUSIONS: This study highlights that prone position Thoracoscopy with Modified Dual Lung Ventilation (MDLV) and conservative ventilation strategies is more physiological with no compromise to surgical technique or patient safety.

Time-O2saturation-Po2

Time(min)	O2 sat%(Mean±SD)	Po2mmHg(Mean±SD)
0min(prone)	98.63±1.17	165.26±62.39
30	94.20±2.36	84.56±25.54
60	94.33±2.37	86.19±20.33
90	94.65±2.70	88.54 ±17.56
120	93.58±3.73	88.24±24.66
Completion	99.05±0.71	229.32±105.02