Intraoperative air leak site detection in spontaneous pneumothorax through carbon dioxide insufflation during thoracoscopic surgery.

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  • Author(s): Kang DY;Kang DY
  • Source:
    Surgical endoscopy [Surg Endosc] 2020 Jan; Vol. 34 (1), pp. 312-316. Date of Electronic Publication: 2019 Mar 28.
  • Publication Type:
    Journal Article
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: Springer Country of Publication: Germany NLM ID: 8806653 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-2218 (Electronic) Linking ISSN: 09302794 NLM ISO Abbreviation: Surg Endosc Subsets: MEDLINE
    • Publication Information:
      Publication: 1992- : New York : Springer
      Original Publication: [Berlin] : Springer International, c1987-
    • Subject Terms:
      Thoracic Surgery, Video-Assisted*/adverse effects ; Thoracic Surgery, Video-Assisted*/methods; Carbon Dioxide/*pharmacology ; Insufflation/*methods ; Intraoperative Care/*methods ; Intraoperative Complications/*diagnosis ; Pneumothorax/*surgery; Adult ; Female ; Humans ; Male ; Middle Aged ; Outcome and Process Assessment, Health Care ; Postoperative Period
    • Abstract:
      Background: Although thoracoscopic surgery is commonly performed in patients with a pneumothorax and persistent air leak, it is still difficult to identify a definite air leak site during thoracoscopic surgery. The purpose of this study was to determine the safety, efficacy, and feasibility of intraoperative air leak site detection in spontaneous pneumothorax through low-pressure carbon dioxide (CO 2 ) insufflation during thoracoscopic surgery.
      Methods: Of 54 patients who underwent thoracoscopic pneumothorax operations between March 2017 and March 2018, 22 pneumothorax patients underwent surgery for a persistent air leak. All patients were intubated with a single- or double-lumen endotracheal tube for general anesthesia. Three-port thoracoscopic surgery was performed, and CO 2 was insufflated into the thoracic cavity at a pressure of 3-5 mmHg under two-lung ventilation to ensure visibility for video-assisted thoracoscopic surgery (VATS) and identification of the air leak site.
      Results: Air leak sites were identified in all but one patient under CO 2 insufflation. No intraoperative or postoperative adverse effects associated with CO 2 insufflation were observed. The operative time was 37.8 ± 14.9 min (range 20-66 min), and the chest tube was removed after an average 2.7 ± 0.7 postoperative days (range 2-4 days). Patients were discharged after an average 4.1 ± 0.9 postoperative days (range 3-6 days). Postoperative recurrence was confirmed in 3 patients during 12.0 ± 4.0 months (range 5-16 months) of follow-up.
      Conclusion: A method to detect an air leak site during VATS for pneumothorax using low-pressure CO 2 appears to be safe, effective, and feasible.
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    • Contributed Indexing:
      Keywords: Air leak; Carbon dioxide insufflation; Lung expansion; Pneumothorax; Thoracoscopic surgery; Thoracoscopic visibility
    • Accession Number:
      142M471B3J (Carbon Dioxide)
    • Publication Date:
      Date Created: 20190330 Date Completed: 20201019 Latest Revision: 20201019
    • Publication Date:
      20221213
    • Accession Number:
      10.1007/s00464-019-06768-0
    • Accession Number:
      30923903