Difficult Management of a Double-Lumen Endotracheal Tube and Difficult Ventilation during Robotic Thymectomy with Carbon Dioxide Insufflation
Robotic surgery with carbon dioxide (CO2) insufflation to the thorax is frequently performed to gain a better operative field of view, although its intraoperative complications have not yet been discussed in detail. We treated two patients with difficult ventilation caused by distal migration of a d...
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| Format: | Article |
| Language: | English |
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Wiley
2017-01-01
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| Series: | Case Reports in Surgery |
| Online Access: | http://dx.doi.org/10.1155/2017/3403045 |
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| author | Yuki Sugiyama Kunihiro Mitsuzawa Yuki Yoshiyama Fumiko Shimizu Satoshi Fuseya Takashi Ichino Hiroyuki Agatsuma Takayuki Shiina Ken-ichi Ito Mikito Kawamata |
| author_facet | Yuki Sugiyama Kunihiro Mitsuzawa Yuki Yoshiyama Fumiko Shimizu Satoshi Fuseya Takashi Ichino Hiroyuki Agatsuma Takayuki Shiina Ken-ichi Ito Mikito Kawamata |
| author_sort | Yuki Sugiyama |
| collection | DOAJ |
| description | Robotic surgery with carbon dioxide (CO2) insufflation to the thorax is frequently performed to gain a better operative field of view, although its intraoperative complications have not yet been discussed in detail. We treated two patients with difficult ventilation caused by distal migration of a double-lumen endotracheal tube (DLT) during robotic thymectomy. In the first case, migration of the DLT during one-lung ventilation (OLV) occurred after CO2 insufflation to the bilateral thoraxes was started. Oxygenation rapidly deteriorated because dependent lung expansion was restricted by CO2 insufflation. In the second case, migration of the DLT during OLV occurred while CO2 insufflation to a unilateral thorax and mediastinum was performed. In both cases, once migration of the DLT during OLV occurred with CO2 insufflation, readjusting the DLT became very difficult because our manipulation of bronchofiberscopy was prevented by the robot arms located above the patient’s head and because deformation of the trachea/bronchus induced by CO2 insufflation caused a poor image of the bronchofiberscopic view. Thus, during robotic-assisted thoracoscopic surgery with CO2 insufflation, since there is a potential risk of difficult ventilation with a DLT and since readjustment of the DLT is very difficult, discontinuing CO2 insufflation and switching to double-lung ventilation are needed in such a situation. |
| format | Article |
| id | doaj-art-9cbc950f57ea4ab58114dbc12ccc00ed |
| institution | Kabale University |
| issn | 2090-6900 2090-6919 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Surgery |
| spelling | doaj-art-9cbc950f57ea4ab58114dbc12ccc00ed2025-02-03T06:07:58ZengWileyCase Reports in Surgery2090-69002090-69192017-01-01201710.1155/2017/34030453403045Difficult Management of a Double-Lumen Endotracheal Tube and Difficult Ventilation during Robotic Thymectomy with Carbon Dioxide InsufflationYuki Sugiyama0Kunihiro Mitsuzawa1Yuki Yoshiyama2Fumiko Shimizu3Satoshi Fuseya4Takashi Ichino5Hiroyuki Agatsuma6Takayuki Shiina7Ken-ichi Ito8Mikito Kawamata9Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, JapanDepartment of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, JapanDepartment of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, JapanDepartment of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, JapanDepartment of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, JapanDepartment of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, JapanDivision of Breast, Endocrine and Respiratory Surgery, Department of Surgery (II), Shinshu University School of Medicine, Matsumoto, JapanDivision of Breast, Endocrine and Respiratory Surgery, Department of Surgery (II), Shinshu University School of Medicine, Matsumoto, JapanDivision of Breast, Endocrine and Respiratory Surgery, Department of Surgery (II), Shinshu University School of Medicine, Matsumoto, JapanDepartment of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, JapanRobotic surgery with carbon dioxide (CO2) insufflation to the thorax is frequently performed to gain a better operative field of view, although its intraoperative complications have not yet been discussed in detail. We treated two patients with difficult ventilation caused by distal migration of a double-lumen endotracheal tube (DLT) during robotic thymectomy. In the first case, migration of the DLT during one-lung ventilation (OLV) occurred after CO2 insufflation to the bilateral thoraxes was started. Oxygenation rapidly deteriorated because dependent lung expansion was restricted by CO2 insufflation. In the second case, migration of the DLT during OLV occurred while CO2 insufflation to a unilateral thorax and mediastinum was performed. In both cases, once migration of the DLT during OLV occurred with CO2 insufflation, readjusting the DLT became very difficult because our manipulation of bronchofiberscopy was prevented by the robot arms located above the patient’s head and because deformation of the trachea/bronchus induced by CO2 insufflation caused a poor image of the bronchofiberscopic view. Thus, during robotic-assisted thoracoscopic surgery with CO2 insufflation, since there is a potential risk of difficult ventilation with a DLT and since readjustment of the DLT is very difficult, discontinuing CO2 insufflation and switching to double-lung ventilation are needed in such a situation.http://dx.doi.org/10.1155/2017/3403045 |
| spellingShingle | Yuki Sugiyama Kunihiro Mitsuzawa Yuki Yoshiyama Fumiko Shimizu Satoshi Fuseya Takashi Ichino Hiroyuki Agatsuma Takayuki Shiina Ken-ichi Ito Mikito Kawamata Difficult Management of a Double-Lumen Endotracheal Tube and Difficult Ventilation during Robotic Thymectomy with Carbon Dioxide Insufflation Case Reports in Surgery |
| title | Difficult Management of a Double-Lumen Endotracheal Tube and Difficult Ventilation during Robotic Thymectomy with Carbon Dioxide Insufflation |
| title_full | Difficult Management of a Double-Lumen Endotracheal Tube and Difficult Ventilation during Robotic Thymectomy with Carbon Dioxide Insufflation |
| title_fullStr | Difficult Management of a Double-Lumen Endotracheal Tube and Difficult Ventilation during Robotic Thymectomy with Carbon Dioxide Insufflation |
| title_full_unstemmed | Difficult Management of a Double-Lumen Endotracheal Tube and Difficult Ventilation during Robotic Thymectomy with Carbon Dioxide Insufflation |
| title_short | Difficult Management of a Double-Lumen Endotracheal Tube and Difficult Ventilation during Robotic Thymectomy with Carbon Dioxide Insufflation |
| title_sort | difficult management of a double lumen endotracheal tube and difficult ventilation during robotic thymectomy with carbon dioxide insufflation |
| url | http://dx.doi.org/10.1155/2017/3403045 |
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