Application of Right Bronchial Occlusion Under Artificial Pneumothorax in the Thoracic Phase of Minimally Invasive Mckeown Oesophagectomy

Background: To evaluate the feasibility and safety of single-lumen endotracheal intubation combined with right bronchial occlusion under artificial pneumothorax in minimally invasive McKeown oesophagectomy. Methods: A total of 165 patients who underwent minimally invasive McKeown oesophagectomy at Peking Union Medical College Hospital from 2014 to 2019 were retrospectively analysed. A total of 117 patients received single-lumen endotracheal intubation combined with right bronchial occlusion (SLET-B group), and 48 patients received double-lumen endotracheal intubation (DLET group). Clinical data, intraoperative haemodynamics, surgical variables, and postoperative complications were analysed and compared. Results: The clinical characteristics of the two groups were similar. Compared with the DLET group, a shorter intubation time and lower tube dislocation rate were found in the SLET-B group (P <0.05). In the thoracic phase, with the application of artificial pneumothorax, patients in the SLET-B group had lower PaCO 2 and PetCO 2 values and higher pH (P <0.05) than those in the DLET group. These parameters gradually returned to normal half an hour after the thoracic phase. Patients in the SLET-B group had shorter thoracic phase times and hospital stays and less intraoperative haemorrhage than those in the DLET group. The numbers of thoracic and bilateral recurrent laryngeal lymph nodes harvested were significantly higher in the SLET-B group. Conclusions: Compared with double-lumen endotracheal intubation anaesthesia, single-lumen endotracheal intubation combined with right bronchial occlusion under artificial pneumothorax is feasible and safe in minimally invasive McKeown oesophagectomy. It has great advantages in surgical safety and the number of thoracic lymph nodes harvested.