Background : Minimal access mediastinal surgery (MAMS) is usually
performed under general anaesthesia with double lumen tubes (DLT). The
aim of this study is to evaluate two lung ventilation through single
lumen tubes (SLT) during thoracoscopic sympathectomy for hyperhidrosis
and thoracoscopic thymectomy for myasthenia gravis. Methods : In this
prospective non-randomized study, MAMS was performed in 58 patients
with hyperhidrosis and 42 patients with myasthenia gravis, from January
2002 to December 2008. Patients were intubated with a DLT or SLT, 50
patients in each group. In the DLT group, endobronchial tubes were
placed using the traditional blind approach and one lung ventilation
was confirmed clinically. In the SLT group, the hemithorax was
insufflated with CO2 in conjunction with two-lung anaesthesia. All the
patients were evaluated for haemodynamic stability, oxygen saturation
of haemoglobin (Spo2), end-tidal Pco2 (ETPco2), times required for
intubation and surgery, satisfaction of surgeon with regard to exposure
and postoperative complications. Results : In the SLT group, all the
patients had stable haemodynamic and ventilation parameters. In the DLT
group, haemodynamic instability occurred in two, decrease in Spo2 in
four and increase in ETPco2 in three patients. One patient in the DLT
group developed vocal cord granuloma two months later. Time required
for surgery and the surgeon′s opinion with regard to exposure
were similar for both groups. Conclusion : Thoracoscopic surgery when
used in cases where a well-collapsed lung may not be essential, since
surgery is not performed on the lung itself, does not require DLT. SLT
is safe in MAMS. It provides good surgical exposure and decreases the
cost, time and undesirable complications of DLT