Efficacy of CO2 insufflation during thoracoscopic esophagectomy in the left lateral position.

OBJECTIVE: Thoracoscopic esophagectomy (TE) is widely performed as a minimally invasive technique in the management of esophageal cancer. The aim of this study was to estimate the efficacy of intrathoracic carbon dioxide (CO2) insufflation during TE in the left lateral position. METHODS: From January 2010 to April 2016, 58 patients with esophageal cancer underwent TE without intrathoracic CO2 insufflation (Group N) and 37 patients with esophageal cancer underwent TE with intrathoracic CO2 insufflation (Group C). The operation results and respiratory parameters during the thoracic procedure were compared in both groups. RESULTS: A satisfactory surgical field was obtained by CO2 insufflation. There was no difference in the duration of the thoracic procedure or number of dissected mediastinal lymph nodes between the two groups. The amount of thoracic blood loss in Group C was significantly less than that in Group N (P < 0.05). Intrathoracic CO2 insufflation did not affect oxygenation during single-lung ventilation. However, both end-tidal CO2 (ETCO2) 1 h after single-lung ventilation and maximum ETCO2 in Group C were significantly higher than those in Group N. Intraoperative hypercapnia in Group C was permissive. The rate of extubation in the operation room, mortality and morbidity were not different between the two groups. CONCLUSIONS: Intrathoracic CO2 insufflation is beneficial to make satisfactory surgical field and to reduce thoracic blood loss in TE. Application of intrathoracic CO2 insufflation may contribute to the widespread adoption of TE in the left lateral position.