VivaSight™ single-lumen tube guided bronchial blocker placement for one-lung ventilation in a patient with a tracheal tumor under video-assisted transthoracic surgery: A case report

- VivaSight ™ single-lumen tube guided.
- bronchial blocker placement for one-lung ventilation in a patient with a tracheal tumor under video-assisted transthoracic surgery: a case report.
- Background: Video-assisted transthoracic surgery (VATS) is a minimally invasive procedure that has been reported as a valid method for tracheal resection and reconstruction.
- However, for patients with tracheal tumors, one-lung ventilation during VATS is difficult to achieve, and utilizing a double-lumen tube is not applicable in these types of situations.
- When using a bronchial blocker, a fiberoptic bronchoscope is required to verify the position of bronchial blocker, though the repeated use of the fiberoptic bronchoscope increases the risk of tumor rupture and.
- Case presentation: We report a case with a middle tracheal tumor received tracheal resection and reconstruction under VATS, in which VivaSight ™ single-lumen tube guided bronchial blocker placement was used for achieving one-lung ventilation.
- The VivaSight ™ single-lumen tube can provide real-time and continuous monitoring of the position of bronchial blocker.
- Conclusions: VivaSight ™ single-lumen tube combined with a bronchial blocker is a feasible choice for one-lung ventilation in this type of surgery..
- Keywords: One-lung ventilation, Bronchial blocker, Thoracic surgery.
- Tracheal resection and reconstruction are often used for treating malignant tracheal tumors, which are difficult pro- cedures for both the thoracic surgeon and anesthesiologist involved.
- Video-assisted transthoracic surgery (VATS) is a minimally invasive procedure that has been reported as a valid method for tracheal resection and reconstruction [1, 2].
- However, for patients with tracheal tumors, one-lung ventilation during VATS is difficult to achieve..
- A double-lumen tube (DLT) is not indicated in this situation, because it can destroy the tumor and lead to the risk of bleeding [3, 4].
- the position of bronchial blocker, though the repeated use of the fiberoptic bronchoscope increases the risk of tumor rupture and hemorrhage.
- VivaSight™ single-lumen tube (SLT) (ETView Ltd., Misgav, Israel) is the new generation of endotracheal tubes incorporating a high-resolution imaging camera and a light source in its tip.
- It can guide the placement of bronchial blocker without the aid of fiberoptic bronchoscopy.
- Theoretically, it makes place- ment of a bronchial blocker faster and provides continu- ous visualization.
- We report a case of a middle tracheal tumor in which VivaSight™ SLT guided bronchial blocker placement was used for one-lung ventilation under VATS..
- 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0.
- scan of the chest revealed a tracheal lesion in the middle trachea (Shown in Fig.
- Bronchoscopy showed a tumor encroaching into the left tracheal wall of the middle tra- chea.
- A biopsy was positive for an adenoid cystic carcin- oma of the trachea.
- The patient’ s electrocardiogram showed changes of ST-T in the anterior lateral wall and the inferior wall..
- To avoid the stress response of open thoracotomy, the patient was scheduled for tracheal resec- tion and reconstruction under VATS..
- After arrival in the operating room, routine monitoring including electrocardiography, blood pressure, and pulse oximetry were applied.
- Catheterization of the radial artery was performed under local anesthesia for continuous blood pressure monitoring as well as blood gas analysis..
- Under visual guidance of the imaging camera in the tip, an internal diameter (ID) of 7.5 mm VivaSight™.
- A 9F bronchial blocker was placed in the right main bronchus under the guidance of VivaSight ™ SLT.
- The cuff of the bronchial blocker was inflated with the volume necessary to seal the bronchus (8 mL air).
- The patient was placed in the left lateral decubitus and the position of the bronchial blocker was continuously monitored.
- Right video assisted thoracotomy was per- formed uneventfully to separate the trachea.
- Right lung collapse was achieved by deflating the cuff of the bronchial blocker and disconnecting the tube from the ventilator just before the surgeon broke the pleura.
- After a few sec- onds, the cuff of the bronchial blocker was inflated with the same volume of air and one-lung ventilation was achieved..
- After the trachea was well exposed, the bronchial blocker was withdrawn, and a sterile SLT of ID 6.5 mm.
- 1 Chest computed tomography (CT) revealed a local thickening in the middle trachea.
- 2 The VivaSight ™ SLT was placed above the tracheal tumor under the monitor view.
- The white arrow refers to the tumor.
- 3 The placement of the bronchial blocker through the monitor of a VivaSight ™ SLT.
- was placed to the left main bronchus through the incision of the trachea by the surgeon.
- One-lung ventilation was then performed through this tube.
- During tra- cheal anastomosis, the patient was intermittent ventilated through the endobronchial tube, which was inserted from the incision of tracheal by the surgeon.
- For a while, the SLT was re-inserted and the patient was ventilated to restore oxygenation.
- Until the completion of tracheal anastomosis, the patient was ventilated again through the VivaSight SLT.
- After surgery, the patient was transferred to the thoracic ICU with a trachea tube.
- A different approach was selected for tracheal resection and reconstruction in this case, according to the location of the tracheal lesion.
- The upper part of the trachea was generally resected from the neck approach, while the pro- cedure in the lower part of the trachea was performed from the thoracic approach [6].
- With advances in minim- ally invasive techniques and devices, VATS resection and reconstruction of the trachea can achieve radical resection of the tumor [7].
- Considering that this patient had a his- tory of coronary atherosclerosis, VATS-guided resection and reconstruction of the trachea was chosen to reduce the stress response..
- The potential risks include hypoxemia, hypercapnia, uncon- trolled coughing and soiling of the airway with blood and secretions.
- VATS requires a clear exposure of the surgical field..
- DLT is routinely used to achieve one-lung ventilation, while a bronchial blocker is selected in some special situa- tions, such as pediatric patients or difficult airways [4]..
- For patients with a tracheal tumor, one-lung ventilation during VATS is difficult to achieve.
- A tumor in the trachea can hamper the placement of a DLT.
- Second, a bronchial blocker can be considered after an SLT is placed above the tumor..
- However, bronchial blockers are easy to be displaced and they require the use of the fiberoptic bronchoscope to ver- ify its position.
- Therefore, to minimize potential complications of fibreoptic bronchoscopy, the VivaSight SLT was used.
- It allows a continuous visualization of the airway and imme- diate correction if a displacement of the bronchial blocker occurs..
- showed that VivaSight SLT increased the success rate of intubation at the first at- tempt, as compared with direct laryngoscopy [9].
- claimed that VivaSight SLT may be a good first choice for tracheal intubation by a paramedic in a cervical immobilized condition [10].
- VivaSight SLT has also been reported for bronchial blocker placement without bronchoscopy.
- used the VivaSight SLT combined with a bronchial blocker in a case of pyothorax with bronchopleural fistula [16].
- In conclusion, our case demonstrates a novel approach for tracheal resection and reconstruction.
- VivaSight ™ SLT can provide real-time and continuous monitoring of the position of a bronchial blocker and a tracheal patho- logical lesion.
- Thus, VivaSight ™ SLT combined with a bronchial blocker could be a feasible choice for one-lung ventilation in this type of surgery..
- DLT: Double-lumen tube.
- SLT: Single-lumen tube.
- VATS: Video-assisted transthoracic surgery.
- JQ collected all the patient initial data and drafted the manuscript.
- WY raised the initial idea, completed the anesthesia management and made the critical revision of the manuscript..
- Written informed consent was obtained from the patient for publication of this article and any accompanying images.
- A copy of the written consent is available for review by the Editor of this journal..
- Thoracoscopic carinal resection and reconstruction in a patient with mucoepidermoid carcinoma..
- Thoracoscopic tracheal resection and reconstruction for adenoid cystic carcinoma.
- Lung isolation in the patient with a difficult airway.
- Anesthetic management of tracheal resection and reconstruction.
- Video-assisted thoracoscopic surgery tracheal resection and carinal reconstruction for tracheal adenoid cystic carcinoma.
- Comparison of the VivaSight single lumen endotracheal tube and the Macintosh laryngoscope for emergency intubation by experienced paramedics in a standardized airway manikin with restricted access: a randomized, crossover trial.
- One-lung ventilation after rapid-sequence intubation: a novel approach using an ETView tracheoscopic ventilation tube for placement of an EZ-blocker without bronchoscopy

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