Canine cardiopulmonary responses to one-lung ventilation during thoracoscopic diaphragmatic incision repair and two-lung ventilation during gasless laparoscopic diaphragmatic incision repair
Two minimally invasive surgical techniques for repair of diaphragmatic incisions and the cardiopulmonary responses during the surgical procedures were investigated in dogs;(1) The cardiopulmonary effects of one-lung ventilation (OLV) during thoracoscopic diaphragmatic incision repair (TDIR) and two-lung ventilation (TLV) for gasless laparoscopic diaphragmatic incision repair (GLDIR) in the dog were determined. The changes in cardiopulmonary function were less in the GLDIR with TLV group, although not statistically different from the TDIR with OLV. In addition, during OLV and thoracoscopy, right lung collapse with left lung ventilation may predispose to an increased risk of hypoxemia when compared to left lung collapse with right lung ventilation;(2) Two video-assisted surgical techniques are described for the repair of diaphragmatic incisions: (a) gasless laparoscopy with an abdominal lifting device and (b) thoracoscopy with one-lung ventilation. In this study, thoracoscopic approaches with OLV were feasible to repair the diaphragmatic incisions located in the ventral part of the right pars costalis and sternalis or left pars costalis and sternalis. Incisions that extended across the midline were more difficult to repair with this approach. The gasless laparoscopic approach was feasible to suture incisions located in the pars sternalis and ventral part of the right or left pars costalis. Incisions that extended across the midline were repairable with this approach. The two surgical approaches described have potential clinical application that would provide a reduction in pain and recuperation times from diaphragmatic hernia repair for clinical patients.