Strategy For Thoracoscopic Surgery In Patients Having Difficulty With One-lung Ventilation
Mitsuhiro Kamiyoshihara, Hitoshi Igai, Takashi Ibe, Natsuko Kawatani, Fumi Ohsawa, Ryohei Yoshikawa.
Maebashi Red Cross Hospital, Maebashi, Japan.
OBJECTIVE: We experienced three patients in a severe condition who were placed on one-lung ventilation during video-assisted thoracoscopic surgery (VATS). We applied extracorporeal membrane oxygenation (ECMO) with good results. Here, we present tips for and pitfalls of performing VATS combined with ECMO.
RESULTS: Case #1: A 58-year-old male was admitted due to bilateral pneumothorax. Although the left pneumothorax was treated successfully, severe pulmonary fibrosis prevented VATS under one-lung ventilation for the right pneumothorax. Therefore, a VATS bullectomy was performed, in combination with ECMO. The patient was weaned off mechanical ventilation (MV) on the day of the operation and was discharged on postoperative day (POD) 15. Case #2: A 48-year-old male was admitted with bilateral giant bullae. Due to the possibility that ventilation pressure could expand the bullae during the operation, a VATS bullectomy was performed under ECMO. The patient was weaned off MV on POD 1 and discharged on POD 10. Case #3: A 50-year-old female was admitted due to bilateral pneumothorax with lymphangioleiomyomatosis. A simultaneous bilateral VATS surgical sheet-covering technique for the pulmonary parenchyma was performed under ECMO. The patient was weaned off MV on POD 1 and discharged on POD 23 after introducing home oxygen therapy.
CONCLUSIONS: All patients were able to be taken off ECMO immediately after surgery. None of the three cases experienced complications either during or after surgical intervention. These results suggest that ECMO is an effective treatment in patients undergoing VATS with the added difficulty of one-lung ventilation under general anesthesia.
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