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Efficacy and hemodynamic response of pleural carbon dioxide insufflation during thoracoscopic surgery in a swine vessel injury model

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Abstract

Purposes

Thoracoscopic anatomical lung resection is a minimally invasive technique, but intraoperative massive bleeding is a critical complication. We investigated the hemostatic efficacy and safety of intrapleural carbon dioxide (CO2) insufflation in thoracoscopic surgery in a swine vessel injury model.

Methods

Swines were assigned to one of four groups subjected to thoracoscopic surgery under target intrathoracic pressures of 0, 5, 10, or 15 mmHg CO2 insufflation, respectively. A pin-hole injury of the right cranial lobe pulmonary vein was inflicted thoracoscopically and we compared the blood loss and hemodynamic changes in each group.

Results

There were no signs or echographic findings of air embolus. Both the blood loss per minute and total blood loss during the experiment were significantly lower in the 10 and 15 mmHg groups than in the 0 mmHg group (p > 0.05, respectively). The hemodynamic signs, including heart rate, mean arterial pressure, and peripheral oxygen saturation, were not significantly different in the 0 and 10 mmHg groups at most times, although they were significantly correlated with the insufflation pressure during the experiments (p < 0.05).

Conclusions

CO2 insufflation in thoracoscopic major lung resection appears to be safe, even in the short term, and can help to control vessel injury.

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Abbreviations

CO2 :

Carbon dioxide

HITS:

High-intensity transient signal

References

  1. Yasui H, Osada H, Ide H, Fujimura S. Thoracic and cardiovascular surgery in Japan during 1997. Annual report by the Japanese Association for Thoracic Surgery. Committee of Science. Jpn J Thorac Cardiovasc Surg. 1999;47:237–51.

    Article  CAS  PubMed  Google Scholar 

  2. Sakata R, Fujii Y, Kuwano H. Thoracic and cardiovascular surgery in Japan during 2008: annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2010;58:356–83.

    Article  PubMed  Google Scholar 

  3. Kuwano H, Amano J, Yokomise H. Thoracic and cardiovascular surgery in Japan during 2010: annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2012;60:680–708.

    Article  PubMed  Google Scholar 

  4. Li WW, Lee TW, Lam SS, Ng CS, Sihoe AD, Wan IY, et al. Quality of life following lung cancer resection: video-assisted thoracic surgery vs thoracotomy. Chest. 2002;122:584–9.

    Article  PubMed  Google Scholar 

  5. Nomori H, Cong Y, Sugimura H. Limited thoracotomy for segmentectomy: a comparison of postoperative pain with thoracoscopic lobectomy. Surg Today. 2016 [Epub ahead of print].

  6. Daniels LJ, Balderson SS, Onaitis MW, D’Amico TA. Thoracoscopic lobectomy: a safe and effective strategy for patients with stage I lung cancer. Ann Thorac Surg. 2002;74:860–4.

    Article  PubMed  Google Scholar 

  7. Miyazaki T, Yamasaki N, Tsuchiya T, Matsumoto K, Hatachi G, Kitamura Y, et al. Management of unexpected intraoperative bleeding during thoracoscopic pulmonary resection: a single institutional experience. Surg Today. 2015 [Epub ahead of print].

  8. Sakuragi T, Okazaki Y, Mitsuoka M, Itoh T. Dramatic hemostasis of the transected pulmonary artery model using SOFT COAG electrosurgical output. Interact Cardiovasc Thorac Surg. 2008;7:764–6.

    Article  PubMed  Google Scholar 

  9. Sakuragi T, Ohma H, Ohteki H. Efficacy of SOFT COAG for intraoperative bleeding in thoracic surgery. Interact Cardiovasc Thorac Surg. 2009;9:767–8.

    Article  PubMed  Google Scholar 

  10. Tsunezuka Y, Waseda R, Yachi T. Electrothermal bipolar vessel sealing device LigaSureV for pulmonary artery ligation–burst pressure and clinical experiences in complete video-assisted thoracoscopic major lung resection for lung cancer. Interact Cardiovasc Thorac Surg. 2010;11:229–33.

    Article  PubMed  Google Scholar 

  11. D’Andrilli A, Cavaliere I, Maurizi G, Andreetti C, Ciccone AM, Ibrahim M, et al. Evaluation of the efficacy of a haemostatic matrix for control of intraoperative and postoperative bleeding in major lung surgery: a prospective randomized study. Eur J Cardiothorac Surg. 2015;48:679–83.

    Article  PubMed  Google Scholar 

  12. Engelhardt M, Folkers W, Brenke C, Scholz M, Harders A, Fidorra H, et al. Neurosurgical operations with the patient in sitting position: analysis of risk factors using transcranial Doppler sonography. Br J Anaesth. 2006;96:467–72.

    Article  CAS  PubMed  Google Scholar 

  13. Yamashita S, Tokuishi K, Moroga T, Abe S, Yamamoto K, Miyahara S, et al. Totally thoracoscopic surgery and troubleshooting for bleeding in non-small cell lung cancer. Ann Thorac Surg. 2013;95:994–9.

    Article  PubMed  Google Scholar 

  14. Wolfer RS, Krasna MJ, Hasnain JU, McLaughlin JS. Hemodynamic effects of carbon dioxide insufflation during thoracoscopy. Ann Thorac Surg. 1994;58:404–7.

    Article  CAS  PubMed  Google Scholar 

  15. Ohtsuka T, Nakajima J, Kotsuka Y, Takamoto S. Hemodynamic responses to intrapleural insufflation with hemipulmonary collapse. Surg Endosc. 2001;15:1327–30.

    Article  CAS  PubMed  Google Scholar 

  16. Byhahn C, Mierdl S, Meininger D, Wimmer-Greinecker G, Matheis G, Westphal K. Hemodynamics and gas exchange during carbon dioxide insufflation for totally endoscopic coronary artery bypass grafting. Ann Thorac Surg. 2001;71:1496–501.

    Article  CAS  PubMed  Google Scholar 

  17. Sancheti MS, Dewan BP, Pickens A, Fernandez FG, Miller DL, Force SD. Thoracoscopy without lung isolation utilizing single lumen endotracheal tube intubation and carbon dioxide insufflation. Ann Thorac Surg. 2013;96:439–44.

    Article  PubMed  Google Scholar 

  18. Svenarud P, Persson M, van der Linden J. Effect of CO2 insufflation on the number and behavior of air microemboli in open-heart surgery: a randomized clinical trial. Circulation. 2004;109:1127–32.

    Article  CAS  PubMed  Google Scholar 

  19. Gutt CN, Oniu T, Mehrabi A, Schemmer P, Kashfi A, Kraus T, et al. Circulatory and respiratory complications of carbon dioxide insufflation. Dig Surg. 2004;21:95–105.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We thank Dr. Yusuke Iida for anesthetic management during our experiments and Ms. Amanda Tompson, RN, for correcting the English language in this manuscript.

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Correspondence to Yusuke Takahashi.

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We have no potential conflicts of interest to declare.

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Okamura, R., Takahashi, Y., Dejima, H. et al. Efficacy and hemodynamic response of pleural carbon dioxide insufflation during thoracoscopic surgery in a swine vessel injury model. Surg Today 46, 1464–1470 (2016). https://doi.org/10.1007/s00595-016-1323-7

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  • DOI: https://doi.org/10.1007/s00595-016-1323-7

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