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LETTERS TO THE EDITOR

A Single Lobal Inflation Technique Using Bronchofiberoptic Jet Ventilation During Video-Assisted Thoracoscopic Surgery for Bullae

Department of Anesthesiology, Hyogo Medical Center for Adults, Kitaoji, Akashi-shi, Japan

To the Editor:

Video-assisted thoracoscopic surgery is becoming a standard technique of lung surgery, particularly for bullectomy (1). However, when conventional one-lung ventilation is applied during bullectomy, it is often difficult to obtain a good surgical field to survey bullae because all of the lobes of the upper lung are basically inflated or deflated. An effort to obtain an appropriate surgical field by suppressing the other lobes with an instrument does not always provide a satisfactory result. We tried to inflate a single lobe to be explored with jet ventilation using a fiberoptic bronchoscope. When only this desired lobe is inflated, the other lobes remain collapsed.

When surgeons begin to survey bullae, the bronchoscope is inserted through the tracheal tube and advanced to the orifice of the targeted bronchus, after which high-frequency oscillation starts. We have experience with more than 10 cases. In all cases, only a single lobe was successfully inflated, while the other lobes remained collapsed. Visualization and application of a stapler to bullae was facilitated. Conventionally, to identify air leak sites, saline solution was instilled under slight pulmonary ventilation. In some cases, high-frequency oscillation did not generate air leak. According to a previous study, if the size of the channel of the bronchoscope is larger, then more tidal volume can be generated by jet ventilation (2). Therefore, a larger amount of air leak would be observed with such an improvement.

References

1. Passlick B, Born C, Häussinger K, Thetter O. Efficacy of video-assisted thoracic surgery for primary and secondary spontaneous pneumothorax. Ann Thorac Surg 1998; 65: 324–7.[Abstract/Free Full Text]
2. Sivarajan M, Stoler E, Kil HK, Bishop MJ. A jet ventilation using fiberoptic bronchoscopes. Anesth Analg 1995; 80: 384–7.[Abstract]

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