Skip to main content

Advertisement

SpringerLink
Log in

Comparison of ventilation and cardiovascular parameters between prone thoracoscopic and Ivor Lewis esophagectomy

  • Original Article
  • Published:
Updates in Surgery Aims and scope Submit manuscript

Abstract

Thoracoscopic esophagectomy in the prone position is associated with better surgical ergonomics compared to the left lateral decubitus position due to the effects of gravity pooling blood outside the operative field and the reduced need for lung retraction. The aim of this study was to evaluate the physiological effects of prone thoracoscopic esophagectomy with single-lumen intubation on ventilation, respiratory gas exchange, and cardiovascular parameters. Thirty-two consecutive patients underwent esophagectomy either through a prone thoracoscopic approach or through a right thoracotomic approach. Samples of arterial and central venous blood, as well as ventilation and cardiovascular parameters were obtained at baseline, during induction of anesthesia, throughout the operation, and after extubation. Patients undergoing prone thoracoscopic esophagectomy showed higher oxygenation levels (p < 0.001), and a significantly lower mean pulmonary shunt fraction (p = 0.001). Perioperative hemodynamics remained stable throughout the surgical procedures. Thoracoscopic esophagectomy in the prone position with two-lung ventilation was associated with a significant improvement of global oxygen delivery and a significant reduction of the pulmonary shunt when compared to the Ivor Lewis operation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Nagpal K, Ahmed K, Vats A, Yakoub D, James D, Ashrafian H, Darzi A, Moorthy K, Athanasiou T (2010) Is minimally invasive surgery beneficial in the management of esophageal cancer? A meta-analysis. Surg Endosc 24:1621–1629

    Article  PubMed  Google Scholar 

  2. Wolfe M, Stahl M, Krause B, Bonavina L, Bruns C, Belka C, Zehentmayr F (2011) Curative treatment of oesophageal carcinoma: current options and future developments. Radiat Oncol 6:55

    Article  Google Scholar 

  3. Bonavina L (2009) Selected commentary to “Fifty-five minimally invasive esophagectomies: a single center experience”. Eur Surg 41(4):194–198

    Article  Google Scholar 

  4. Cuschieri A, Shimi S, Banting S (1992) Endoscopic oesophagectomy through a right thoracoscopic approach. J R Coll Edimb 37:7–11

    CAS  Google Scholar 

  5. Biere S, Maas K, Bonavina L, Roig Garcia J, van Berge Henegouwen M, Rosman C, Sosef M, de Lange E, Bonjer H, Cuesta M, van der Peet D (2011) Traditional invasive vs minimally invasive esophagectomy: a multi-center, randomized trial (TIME-trial protocol). BMC Surg 11:2

    Article  PubMed  Google Scholar 

  6. Jarral O, Purkayastha S, Athanasiou T, Zacharakis E (2011) Should thoracoscopic three stage esophagectomy be performed in the prone or left lateral decubitus position? Interact CardioVasc Thorac Surg 13:60–65

    Article  PubMed  Google Scholar 

  7. Palanivelu C, Prakash A, Senthilkumar R, Senthilnathan O, Parthasarathi R, Rajan P, Venkatachlam S (2006) Minimally invasive esophagectomy: thoracoscopic mobilization of the esophagus and mediastinal lymphadenectomy in prone position. Experience of 130 patients. JACS 203:7–16

    Google Scholar 

  8. Smith RH (1974) One solution to the problem of the prone position for surgical procedures. Anesth Analg 53:211–224

    Google Scholar 

  9. Bonavina L, Bona D, Binjom P, Peracchia A (2004) Laparoscopy-assisted surgical approach to esophageal carcinoma. J Surg Res 117:52–57

    Article  PubMed  Google Scholar 

  10. Gattinoni L, Pelosi P, Valenza F, Mascheroni D (1994) Patient positioning in acute respiratory failure. In: Tobin MJ (ed) Principle and practice of mechanical ventilation. McGraw Hill, New York, pp 1067–1076

    Google Scholar 

  11. Pelosi P, Croci M, Calappi E, Cerisara M, Mulazzi D, Vicardi P, Gattinoni L (1995) The prone positioning during general anesthesia minimally affects respiratory mechanics while improving functional residual capacity and increasing oxygen tension. Anesth Analg 80:955–960

    PubMed  CAS  Google Scholar 

  12. Kim DJ, Hyung WJ, Lee CY, Lee J, Haam SJ, Park I, Chung KJ (2010) Thoracoscopic esophagectomy for esophageal cancer: feasibility and safety of robotic assistance in the prone position. J Thorac Cardiovasc Surg 139:53–59

    Article  PubMed  Google Scholar 

  13. Cheng YJ, Chan KC, Chien CT et al (2006) Oxidative stress during 1-lung ventilation. J Thorac Cardiovasc Surg 132:513–518

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of General Surgery, IRCCS Policlinico San Donato, University of Milano Medical School, Milan, Italy

    Luigi Bonavina, Letizia Laface, Emmanuele Abate & Marco Nencioni

  2. Department of Anesthesia, IRCCS Policlinico San Donato, University of Milano Medical School, Milan, Italy

    Michele Punturieri & Emiliano Agosteo

  3. Dipartimento di Universitario di Chirurgia, IRCCS Policlinico San Donato, Piazza E. Malan 2, 20097, San Donato Milanese, Milan, Italy

    Luigi Bonavina

Authors
  1. Luigi Bonavina
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Letizia Laface
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emmanuele Abate
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michele Punturieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Emiliano Agosteo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marco Nencioni
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luigi Bonavina.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bonavina, L., Laface, L., Abate, E. et al. Comparison of ventilation and cardiovascular parameters between prone thoracoscopic and Ivor Lewis esophagectomy. Updates Surg 64, 81–85 (2012). https://doi.org/10.1007/s13304-012-0156-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13304-012-0156-1

Keywords

Search

Navigation