Update on Minimally invasive lung lobectomies

Thoracoscopy is a minimally invasive operative procedure for the examination of the pleural cavity and its organs. With the development of high-resolution micro-cameras, video optics, and fiberoptic light delivery systems, clear magnified images of the surgical field can be transferred to a video screen. The ability to perform diagnostic and advanced therapeutic procedures is possible with minimally invasive video-assisted endoscopy in combination with minimally invasive surgical instruments.

Instrumentation
To perform a lung lobectomy stapling equipment is required. An EndoGIA is used for the procedure, and it comes in three different lengths for the cartridges: 30, 45, and 60 mm. Staples are 2.0, 2.5, 3.5 or 4.8 mm long before closure. The EndoGIA places 6 rows of staples and cut in between.

Thoracoscopy technique:
Anesthesia
One-lung ventilation technique with selective intubation of either the left or the right lungs will allow a better exposure of the hile of the lungs. It will facilitate placement of the stapling equipment. One entire lung is going to be excluded during the procedure. A bronchial blocker can be used instead of selective intubation to achieve one-lung ventilation. The blocker will be placed in the lung lobe that needs to stay deflated. When one-lung ventilation is used, the non-ventilated lung is going to collapse. The non-ventilated lung is then creating a shunt, which results in severe hypoxemia. Arterial blood gases are needed to monitor oxygenation of the patient. Positive end expiratory pressure can be applied to improve oxygen saturation during one lung ventilation. Positive end expiratory pressure is not affecting cardiac output or oxygen delivery during one lung ventilation and thoracoscopy.  [...]