Manabu Yasuda1, Ryoichi Nakanishi2, Shinji Shinohara1, Masataka Mori1, Syuhei Ashikari1, Tsunehiro Oyama1, Takeshi Hanagiri1. 1. Department of Thoracic Surgery, Shin-kokura Hospital, Federation of National Public Service, Personnel Mutual Aid Associations, Kitakyushu, Japan. 2. Department of Oncology, Immunology and Surgery, Graduate School of Medical Sciences and Medical School, Nagoya City University, Nagoya, Japan.
Abstract
BACKGROUND: It is difficult to perform thoracoscopic lobectomy in patients with a history of contralateral lobectomy, as stable oxygenation is not always maintained under conditions of one-lung ventilation during surgery. METHODS: This study evaluated 14 patients who underwent thoracoscopic lobectomy after previously undergoing contralateral lobectomy at a single institution between 2008 and 2015. RESULTS: Among 14 patients who had previously received contralateral lobectomy, 4 were unable to maintain sufficient perioperative oxygenation with usual one-lung ventilation. The predicted pulmonary function before surgery in these patients was as follows: both (I) predicted postoperative forced expiratory volume in 1 second <800 mL/m2; and (II) ≤5 contralateral residual segments for ventilation. Regarding special oxygenation techniques, two underwent selective ventilation using lobe-selective bronchial blockade, one underwent intermittent positive airway pressure for operative side lung, and one underwent high-frequency jet ventilation for operative residual lobe. CONCLUSIONS: When performing thoracoscopic lobectomy in patients with a history of contralateral lobectomy, a careful evaluation of the preoperative pulmonary function is needed.
BACKGROUND: It is difficult to perform thoracoscopic lobectomy in patients with a history of contralateral lobectomy, as stable oxygenation is not always maintained under conditions of one-lung ventilation during surgery. METHODS: This study evaluated 14 patients who underwent thoracoscopic lobectomy after previously undergoing contralateral lobectomy at a single institution between 2008 and 2015. RESULTS: Among 14 patients who had previously received contralateral lobectomy, 4 were unable to maintain sufficient perioperative oxygenation with usual one-lung ventilation. The predicted pulmonary function before surgery in these patients was as follows: both (I) predicted postoperative forced expiratory volume in 1 second <800 mL/m2; and (II) ≤5 contralateral residual segments for ventilation. Regarding special oxygenation techniques, two underwent selective ventilation using lobe-selective bronchial blockade, one underwent intermittent positive airway pressure for operative side lung, and one underwent high-frequency jet ventilation for operative residual lobe. CONCLUSIONS: When performing thoracoscopic lobectomy in patients with a history of contralateral lobectomy, a careful evaluation of the preoperative pulmonary function is needed.
Entities:
Keywords:
Thoracoscopic lobectomy; predicted postoperative lung function; special oxygenation technique
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