Application of Carbon Dioxide for Identifying the Intersegmental Plane in Thoracoscopic Segmentectomy
Condition: Lung Cancer; Pulmonary Nodule, Solitary; Segmentectomy; Pulmonary Nodule, Multiple
MeSH terms: Multiple Pulmonary Nodules; Solitary Pulmonary Nodule
Study type: Interventional

Summary: 
      With the increasing acceptance of routine computed tomography (CT) screenings, early-stage
      lung cancer detection is becoming more frequent. For ground glass opacity predominant
      early-stage lung cancer, segmentectomy can get the same oncological benefits as lobectomy. In
      addition, lung nodules that are highly suspected to be metastases can also be performed by
      segmentectomy to preserve more lung function. During the surgery, the rapid and precise
      identification of the intersegmental plane is one of the challenges. The improved
      inflation-deflation method is currently the most widely used method in clinical practice.
      According to the dispersion coefficient of the gas, the rapid diffusion properties of carbon
      dioxide would be expected to speed lung collapse and so facilitate surgery. The purpose of
      this study was to investigate the feasibility and safety of carbon dioxide on the appearance
      time of satisfactory and ideal planes during segmentectomy.
    

Detailed description: 
      This study was approved by the ethics committee of Tongji Hospital, Tongji Medical College,
      Huazhong University of Science and Technology. This randomized parallel group trial enrolled
      patients scheduled to receive thoracoscopic anatomic segmentectomy at Tongji Hospital.
      General anesthesia with double lumen endotracheal tube was administered to the patients. With
      the guidance of preoperative three-dimensional computed tomography bronchography and
      angiography, the targeted segment structures could be precisely dissected, and then
      intersegmental demarcation was confirmed by the modified inflation-deflation method in this
      study. In group A (100% oxygen), after dividing all the targeted vascular and bronchial
      structures, the lung of the operating side was re-inflated with 100% oxygen. In group B
      (Carbon dioxide), after the targeted segment structures were successfully dissected, the
      collapsed operative lung was completely re-expanded with carbon dioxide. The purpose of this
      study was to investigate the feasibility and safety of carbon dioxide on the appearance time
      of satisfactory and ideal planes during segmentectomy. The starting time point of the
      intersegmental plane was when the whole lungs had completely re-expanded. The end point was
      when the preserved segment was fully deflated, and a boundary had formed between the targeted
      segment and the reserved lung.
    

Intervention name(s): 100% oxygen; Carbon dioxide
Intervention type(s): Procedure; Procedure
Intervention description(s): During one-lung ventilation with an open chest, the non-ventilated lung collapses initially due to the inherent elastic recoil properties of the lung. Once passive venting has ceased, further collapse will then be wholly dependent on ongoing gaseous uptake and absorption atelectasis. Improved inflation-deflation method is currently the most widely used method in clinical practice. After dividing all the targeted vascular and bronchial structures, the lung of the operating side was re-inflated with 100% oxygen. After the operative lungs is completely expanded, perform pure oxygen mechanical single lung ventilation for the healthy lung, waiting for clear presentation of the plane between the targeted segment and the other segments.; During one-lung ventilation with an open chest, the non-ventilated lung collapses initially due to the inherent elastic recoil properties of the lung. Once passive venting has ceased, further collapse will then be wholly dependent on ongoing gaseous uptake and absorption atelectasis. The solubility coefficient for carbon dioxide is 0.57. The rapid diffusion properties of carbon dioxide would be expected to speed lung collapse and so facilitate surgery. After the targeted segment structures were successfully dissected, the collapsed intraoperative lung was completely re-expanded with carbon dioxide. After the operative lungs is completely expanded, perform pure oxygen mechanical single lung ventilation for the healthy lung, waiting for clear presentation of the plane between the targeted segment and the other segments.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Lung segmentectomy; Intersegmental plane; Inflation-deflation method; Carbon dioxide