Cardiothoracic Surgery Department, New Cross Hospital, Royal Wolverhampton NHS Foundation Trust, Wolverhampton, United Kingdom.
The Royal Wolverhampton NHS Trust WV10 0QP Heath town Wolverhampton UK.
Multimed Man Cardiothorac Surg. 2024 Sep 26;2024. doi: 10.1510/mmcts.2024.085.
Carinal reconstruction remains a technically challenging procedure for thoracic surgeons due to the complexity of airway resection and management. This is typically performed in the setting of tumour resection affecting the carina and distal trachea. Airway management of patients undergoing surgical resection of tumours involving the carina is highly challenging. This is due to an open, shared airway and the need for single-lung ventilation to facilitate surgery. Common modalities used for intraoperative ventilation include cross-table ventilation, veno-venous extra-corporeal membrane oxygenation and cardiopulmonary bypass. Cardiopulmonary bypass is usually avoided due to the requirement of full heparinization, which increases the demands of a technically challenging procedure, in addition to its contraindication in oncological resections. Extra-corporeal membrane oxygenation is not readily available in most thoracic units. This leaves cross-table ventilation, which is commonly used for open thoracotomy and sternotomy cases, but has never been reported for minimally invasive procedures. Specifically, to the best of our knowledge, cross-table ventilation has never been used for minimally invasive robotic carinal reconstruction. We present a step-by-step video tutorial in performing surgical resection of a mediastinal tumour that was found invading the carina. This was performed in a young patient who underwent carinal reconstruction using a novel technique combining cross-table ventilation and robotic-assisted surgery.
隆嵴重建仍然是胸外科医生面临的一项具有挑战性的技术操作，这主要是由于气道切除和管理的复杂性所致。这种手术通常是在肿瘤累及隆嵴和远端气管的情况下进行的。隆嵴切除术患者的气道管理极具挑战性。这是由于气道开放、共用，以及需要单肺通气来辅助手术。术中通气的常用方法包括交叉通气、静脉-静脉体外膜氧合和体外循环。由于需要充分肝素化，体外循环通常被避免，这增加了技术挑战性操作的需求，此外，其在肿瘤切除中的应用也受到限制。体外膜氧合在大多数胸科单位都不容易获得。因此，只剩下交叉通气可用，这种方法常用于开放性开胸和胸骨切开术，但从未用于微创程序。具体来说，据我们所知，交叉通气从未用于微创机器人隆嵴重建。我们展示了一个分步视频教程，用于对侵犯隆嵴的纵隔肿瘤进行手术切除。该手术在一名年轻患者中进行，该患者使用了一种新的技术，将交叉通气和机器人辅助手术相结合，进行了隆嵴重建。
