Single-Lumen Tube Intubation with CO₂ Insufflation versus Double-Lumen Tube Intubation in Video-Assisted...

Video-assisted transthoracic esophagectomy (VATE) is typically performed with double-lumen tube intubation (DLTI) to facilitate 1-lung ventilation. Single-lumen tube intubation (SLTI) with CO₂ insufflation offers an alternative approach, enabling 2-lung ventilation with artificial pneumothorax, which may improve surgical exposure and reduce pulmonary complications. This study compared the efficacy and safety of SLTI with CO₂ insufflation versus DLTI in VATE.

This retrospective study included 94 male patients who underwent VATE for esophageal cancer at 108 Military Central Hospital between November 2018 and September 2023. Patients were divided into 2 groups: SLTI with CO₂ insufflation (n=44) and DLTI (n=50). The assessed outcomes included lymph node yield, operative time, postoperative complications, intensive care unit (ICU) admission, and length of hospital stay.

The SLTI group had a significantly higher left recurrent laryngeal nerve lymph node yield (2.22±2.65 vs. 0.77±2.14, p=0.008) and a greater total lymph node harvest (23.91±9.22 vs. 19.00±11.75, p=0.02) than the DLTI group. Operative time was longer in the SLTI group for the thoracic phase (168.64±23.69 minutes vs. 142.12±24.17 minutes, p=0.04) and overall (311.82±43.67 minutes vs. 272.68±35.97 minutes, p=0.001). Postoperative complication rates and length of hospital stay did not differ significantly between groups, although ICU admission was more frequent with SLTI (84.1% vs. 56.0%, p=0.003).

SLTI with CO₂ insufflation is a safe and feasible alternative to DLTI in VATE, enabling more extensive recurrent laryngeal lymph node dissection but requiring longer operative times.