Comparison of Clinical Problems in Thoracoscopic Esophagectomy between Prone Position with Pneumothorax Procedure and Lateral Position

Study Objective: We compared the effects of intraoperative body position on blood gas and fluid balance in patients undergoing a thoracoscopic esophagectomy as well as during operation and postoperative laboratory data. Design: Prospective study. Setting: Operating room and intensive care unit. Patients: ASA physical status 1 and 2 patients (n = 26), scheduled for elective thoracoscopic esophagectomy and immediate reconstruction under general anesthesia with one-lung ventilation were enrolled. Interventions: Patients were assigned to either the lateral (n = 16) or prone (n = 10) position groups based on the planned intraoperative body position. A pneumothorax procedure was concomitantly performed only in the prone position group. Measurements: Fluid balance, PaO2/FIO2 ratio (P/F ratio), and maximum PaCO2 during the operation and postoperative laboratory data were analyzed. Main Results: There were no significant differences between the groups for amount of blood loss, blood transfusion, fluid infusion, or urine output. The P/F ratio during one-lung ventilation was significantly higher in the prone than the lateral position group (379 ± 122 vs. 297 ± 67 mmHg, p = 0.017), as was maximum intraoperative PaCO2 (72.2 ± 15.6 vs. 48.3 ± 6.3 mmHg, p < 0.001). Conclusions: A thoracoscopic esophagectomy in the prone position performed concomitantly with a CO2 pneumothorax procedure resulted in a significantly better P/F ratio during one-lung ventilation as compared to the lateral position, indicating that the prone position is more advantageous for oxygenation.