ANESTHESIA FOR 3-STAGE THORACOSCOPIC ESOPHAGECTOMY - AN INITIAL EXPERIENCE

We report our experience in the anaesthetic management of five patient s undergoing three-stage thoracoscopic oesophagectomy. One patient req uired conversion to open thoracotomy because of extensive pleural adhe sions. The other four patients, aged between 68 and 78, were all chron ic smokers with mid-oesophageal squamous cell carcinoma. The duration of thoracoscopic surgery (and obligatory one-lung ventilation) ranged from 2.5 to 4 hours with total surgical time ranging from 7.5 to 9.5 h ours. Anaesthetic considerations included the use of one-lung ventilat ion to provide surgical access, the cardiorespiratory effects of capno thorax, difficulties in assessing surgical blood loss during thoracosc opic dissection, crowding in the operating room with limitation of acc ess to the patient and the risk of intraoperative dislodgement of the endobronchial tube. Postoperative pulmonary complications were not dec reased in our patients despite the avoidance of thoracotomy. The thora coscopic technique might contribute to pulmonary complications because of prolonged thoracoscopic dissection and unintentional pulmonary inj uries. The concept of minimally invasive surgery needs further evaluat ion when the technique is applied in extensive procedures such as oeso phagectomy.