Video-assisted thoracoscopic total thymectomy: two-lung ventilation with artificial pneumothorax

Objectives: Double-lumen endotracheal tube (DLET) and one-lung ventilation (OLV) have been generally accepted as the classic anesthetic method in video-assisted thoracoscopic total thymectomy (VATT). However, there are still some disadvantages of DLET. Two-lung ventilation (TLV) with single-lumen endotracheal tube (SLET) is considered to be an alternative in VATT to avoid these disadvantages. This study evaluated the safety and feasibility of TLV in VATT by comparing it with OLV cases.Material and methods: We retrospectively screened 198 patients who received TLV unilateral thoracic incision VATT and 117 patients who received OLV unilateral thoracic incision VATT. Perioperative data were analyzed, including surgical variables, intraoperative hemodynamic parameters, and postoperative complications and hospital stay.Results: No significant differences with regard to operative time (p = .146), postoperative hospital stay (p = .553), complications (p = .254), hemodynamic parameters and pulse oxygen saturation (SpO₂) were found between TLV group and OLV group. However, end-tidal CO₂ (EtCO₂) was higher in TLV group at 15 min (39.95 ± 5.03 vs 38.70 ± 4.57, p = .021) and 30 min (41.91 ± 5.50 vs 38.91 ± 4.51, p < .001) after initiation of the operation.Conclusions: It is safe and feasible to adopt TLV using SLET with CO₂ insufflation artificial pneumothorax in unilateral thoracic incision VATT.