CO₂ during single incisional thoracoscopic bleb resection with two-lung ventilation

Area of Science:

• Thoracic Surgery
• Minimally Invasive Surgery
• Anesthesiology

Background:

• Single-incision thoracoscopic surgery (SITS) aims to reduce invasiveness.
• Small tidal two-lung ventilation (ST-TLV) is used in SITS.
• CO2 insufflation is explored to enhance the surgical field in ST-TLV.

Purpose of the Study:

• To compare the surgical field quality and physiological effects of ST-TLV with and without CO2 during SITS.
• To evaluate the impact of CO2 insufflation on patient outcomes in SITS.

Main Methods:

• A prospective study comparing SITS bullectomy under ST-TLV with (group C) and without (group NC) CO2 insufflation.
• Surgical field graded at two key points: thoracoscope introduction and bulla resection.
• Recorded vital signs, arterial blood gas analysis (ABGA), ventilation parameters, and postoperative outcomes.

Main Results:

• CO2 insufflation improved the surgical field only at the initial thoracoscope introduction (P=0.022).
• No significant difference in surgical field quality at bulla resection (P=0.172).
• CO2 group had longer operation times (P=0.019), higher peak airway pressure (P=0.009), and elevated PaCO2 (P=0.012) with lower PaO2 (P=0.024), all within normal ranges. Postoperative outcomes were similar.

Conclusions:

• CO2 insufflation in SITS with ST-TLV does not offer a sustained surgical field advantage.
• The procedure with CO2 insufflation leads to increased operation time and higher airway pressures.
• No significant difference in postoperative recovery or complication rates was observed.