A comparative study of two lung ventilation versus one lung ventilation for video-assisted thoracoscopic esophagectomy in semiprone position (airway management for thoracoscopic esophagectomy)

Abstract

Thoracoscopic esophagectomy is a complex procedure used for the treatment of esophageal cancer in which One Lung Ventilation (OLV) anesthesia is often used with several disadvantages associated mainly with respiratory system. But nowadays, the Two Lung Ventilation (TLV) approach has become popular due to reduction in induction time of anesthesia and better perioperative outcomes. The aim was to compare intraoperative respiratory functions and perioperative surgical parameters between One Lung Ventilation and Two Lung Ventilation anesthesia. Methods: In this randomised, prospective, double-blind study, a total of 80 adult patients (40 patients in each group), posted for video assisted thoracoscopic esophagectomy were included, from January 2021 to August 2022. In the OLV group (40 patients), a double -lumen endotracheal tube was used for One Lung Ventilation, and in the TLV group (40 patients), a single-lumen endotracheal tube was used for Two Lung Ventilation anesthesia. Intraoperative respiratory functions (PaO2 , PaCO2 ,) and perioperative surgical parameters were observed. Student's t-test and Chi-square tests were applied where appropriate. Statistical significance was defined as P < 0.05. (SPSS Version 20, IBM, USA) Results: All 80 patients underwent the thoracoscopic esophagectomy surgery successfully. The Two Lung Ventilation approach had better perioperative lung functions with statistically significant difference in PaO2 values (P value < 0.0001) at one hour and two hours of thoracoscopy, less preparation time for anesthesia (P value 0.014) and thoracoscopy operative time (P value 0.002) without any perioperative complications. Conclusion: Two Lung Ventilation anesthesia is a convenient and safe approach for thoracoscopic esophagectomy with better perioperative respiratory outcomes.