Hypoxemia in minimally invasive esophagectomy for squamous cell carcinoma of lower esophagus

Introduction: Minimally invasive esophage-ctomy for esophageal cancer is the surgical treatment-of-choice, and comprises both thoracoscopy and laparoscopy. The risk of hypoxemia arises during one-lung ventilation in the thoracoscopy stage, especially for patients with reduced lung function, and thus poses significant threat to the surgical outcome. This case report aims to demonstrate one possible solution to minimize hypoxemia in minimally invasive esophagectomy. Case Report: A 55-year-old Southeast-Asian male, with a history of chronic smoking, was presented with dysphagia. Diagnosis of squamous cell carcinoma was made, and minimally invasive esophagectomy was performed. Hypoxemia occurred during the thoracoscopic stage, and the oxygen saturation was stabilized with introduction of positive end-expiratory pressure of 5 cmH2O to reduce atelectasis, and tilting the operating table to the ventilated lung to improve perfusion by gravity. Conclusion: Minimally invasive esophagectomy may be complicated by hypoxemia during onelung ventilation. One possible solution, as demonstrated in this case report, is the provision of a 5 cmH2O positive end-expiratory pressure, and approaching the thoracoscopic stage in a lateral decubitus position with the operating table tilted to the ventilated lung. (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 8 No. 3, March 2017. ISSN – [0976-3198] Int J Case Rep Images 2017;8(3):213–216. www.ijcasereportsandimages.com Lam et al. 213 CASE REPORT PEER REVIEWED | OPEN ACCESS Hypoxemia in minimally invasive esophagectomy for squamous cell carcinoma of lower esophagus Pak Lun Lam, Lam Viet Trung