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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Stephen R. Hazelrigg Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hazelrigg, S. R. Search for Related Content PubMed Articles by Hazelrigg, S. R.

Ann Thorac Surg 2004;77:283
© 2004 The Society of Thoracic Surgeons

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Original article: general thoracic

Invited commentary

Department of Cardiothoracic Surgery, Southern Illinois University School of Medicine, PO Box 19638, 800 N Rutledge, Room D319, Springfield, IL 62794-9638, USA

e-mail: shazelrigg{at}siumed.edu

This paper describes a technique that has worked well for the authors in a small subset of cases that allows partial lung collapse for thoracoscopic procedures. The technique itself appears fairly simple, but in the majority of cases did require the use of carbon dioxide insufflation. This method is designed to replace the need for double lumen endotracheal tubes and single lung ventilation.

Our experience has been very good with the use of double lumen endotracheal tubes. They provide optimal visualization of the surgical field for thoracoscopic procedures and, as such, expedite the rapid performance of these procedures. Although the authors suggest no delays in their surgical times by using this technique, I believe it is quite possible, particularly with more advanced surgical procedures, that using this method will increase the operative time, thereby offsetting any cost advantage from avoiding the double lumen endotracheal tubes. In addition, in the last 10 years with over 3,000 procedures using double lumen endotracheal tubes, we have had only one significant airway injury. I believe that this attests to the general safety of the placement of double lumen endotracheal tubes in experienced hands.

The need for carbon dioxide insufflation changes the flow of the procedure as we perform it today. In fact, we often do not use trocars at our access sites. Instead, we use a simple skin incision with an incision between the intercostal space and then use standard instruments. Adding the need for CO₂ requires keeping seals, and can be cumbersome, while making it difficult to use some of the instrumentation that we normally use.

In summary, I believe that for simple procedures this technique can be utilized. However, for the majority, I am doubtful that there is any clinically significant benefit. There may be a small subset where this technique may have a role, such as those that have severely compromised pulmonary function or where the use of a double lumen endotracheal tube is not possible. For the vast majority of cases, I personally will accept the cost of a double lumen endotracheal tube so that I can achieve optimal visualization.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Stephen R. Hazelrigg Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hazelrigg, S. R. Search for Related Content PubMed Articles by Hazelrigg, S. R.