Single Lung Ventilation versus Two Lungs Ventilation in Video Assisted Thoracoscopic Lung Surgeries

Abstract

Background: General anesthesia through double lumen endotracheal tube providing Single Lung Ventilation is the standard technique used in Video Assisted Thoracoscopic surgeries which allows collapsing & isolating the operated lung so to protect the non-operated one against spread of infection & providing a good surgical exposure. This carries risk of hypoxia, higher cost, the needed training & experiences.Many studies compared different strategies to overcome this conflict including the use of standard single lumen endotracheal intubation for providing Two Lung Ventilation (TLV) in VATS.Objective This study compared TLV to standard SLV in VATS considering incidences of & hypoxia, surgeon’s satisfaction & complications. Patients and Methods: After getting ethical committee approval, patients were randomized to one of two groups (each of 30 patients). SLV using double lumen endotracheal tube & TLV using single lumen endotracheal tube. Intraoperative oxygen saturation, hypoxia, complications, mean surgical duration, surgeon’s satisfaction & postoperative complications were recorded.Results: The SLV group had lower oxygen saturation in the first 3 intra-operative hours. Six patients in SLV group developed hypoxia (SaO2<90%), Four of them were resistant hypoxia not responding to usual treatment. No patients in TLV group developed hypoxia.TLV had longer surgical duration & 16.7% surgeon’s satisfaction versus 100% satisfaction in SLV group.Intraoperative complications (apart from hypoxia) & post-operative ones were comparable in TLV versus SLV.Conclusion: TLV & SLV can be used in VAT. Each strategy has benefits & draw backs. The choice is based on several factors & should be managed through multidisciplinary discussion