A simple and practical intraoperative ventilation technique for uniportal video-assisted thoracoscopic tracheal reconstruction: a case report

Background: Cross field endotracheal intubation is typically performed during tracheal anastomosis to maintain single-lung ventilation. To minimize obstruction of the surgical field by the cross-field tube, special equipment such as high-frequency jet ventilation (HFJV) and extracorporeal membrane oxygenation (ECMO) or advanced techniques such as non-intubated ventilation have been proposed. Here, we describe a simple and practical airway management strategy that requires only conventional ventilators and techniques. Our operation is completed under uniportal video-assisted thoracoscopic surgery (VATS). Case Description: We report a case of tracheal adenoid cystic carcinoma (ACC) presenting with cough with bloody sputum in a 53-year-old man. Computed tomography (CT) and flexible bronchoscopy revealed an irregular polypoid neoplasm attached to the right wall of the distal trachea, which almost completely blocked the tracheal lumen. To relieve the symptoms, transbronchoscopic resection of the tumor, followed by curative resection via uniportal VATS under general anesthesia was performed. To maintain single-lung ventilation during tracheal reconstruction, we took advantage of a thin suction tube [internal diameter (ID) 3 mm; external diameter (ED) 4 mm], which was connected to a conventional ventilator. Specifically, by introducing the suction tube into the distal left main bronchus through the endotracheal tube and blowing 100% oxygen, we achieved satisfactory oxygenation throughout the anastomotic process; and the blood CO2 partial pressure was also acceptable. The view of the anastomotic site was far less obstructed owing to the small diameter of the suction tube, and the anastomotic process was smooth and accurate. Postoperative recovery was good, and no stenosis of the reconstructed trachea was observed at the 3-month follow-up. Conclusions: Our technique proves to be safe and feasible for selected patients with tracheal tumors, and can be a practical choice for medical centers that are not equipped with HFJV or ECMO.