title: Efficacy and hemodynamic response of pleural carbon dioxide insufflation during thoracoscopic surgery in a swine vessel injury model.
abstract: OBJECTIVE
  Thoracoscopic anatomical lung resection is a minimally invasive technique, but intraoperative massive bleeding is a critical complication. We investigated the hemostatic efficacy and safety of intrapleural carbon dioxide (CO2) insufflation in thoracoscopic surgery in a swine vessel injury model.
  
  
  METHODS
  Swines were assigned to one of four groups subjected to thoracoscopic surgery under target intrathoracic pressures of 0, 5, 10, or 15 mmHg CO2insufflation, respectively. A pin-hole injury of the right cranial lobe pulmonary vein was inflicted thoracoscopically and we compared the blood loss and hemodynamic changes in each group.
  
  
  RESULTS
  There were no signs or echographic findings of air embolus. Both the blood loss per minute and total blood loss during the experiment were significantly lower in the 10 and 15 mmHg groups than in the 0 mmHg group (p > 0.05, respectively). The hemodynamic signs, including heart rate, mean arterial pressure, and peripheral oxygen saturation, were not significantly different in the 0 and 10 mmHg groups at most times, although they were significantly correlated with the insufflation pressure during the experiments (p < 0.05).
  
  
  CONCLUSIONS
  CO2insufflation in thoracoscopic major lung resection appears to be safe, even in the short term, and can help to control vessel injury.
authors.affiliation: Department of General Thoracic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8606, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Okamura
authors.affiliation: Department of General Thoracic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8606, Japan. yusuketakahashigts@gmail.com.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Department of General Thoracic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8606, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Dejima
authors.affiliation: Department of General Thoracic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8606, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakayama
authors.affiliation: Department of General Thoracic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8606, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Uehara
authors.affiliation: Department of General Thoracic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8606, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Matsutani
authors.affiliation: Department of General Thoracic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8606, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kawamura
mesh_terms: D000818:Animals; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002245:Carbon Dioxide / Q000008:administration & dosage*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006488:Hemostasis, Surgical / Q000379:methods*; D007327:Insufflation / Q000379:methods*; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control; D023421:Models, Animal; D010994:Pleura; D011013:Pneumonectomy / Q000379:methods*; D011667:Pulmonary Veins / Q000293:injuries*; D013552:Swine; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*
chemical_list: D002245:Carbon Dioxide
keywords: Animal model; Bleeding control; Endoscopic procedure; Pulmonary vein; VATS