Robot-assisted thoracoscopic tracheal carina resection and reconstruction under spontaneous-ventilation anesthesia with a single-lumen endotracheal tube: case report and literature review.

BACKGROUND: Robot-assisted thoracoscopic carina resection and reconstruction using non-intubated laryngeal mask airway with spontaneous ventilation has been reported. However, no cases have been described using a single-lumen endotracheal tube under spontaneous-ventilation anesthesia. We report a case of a patient who developed carinal malignancy two years after right middle and lower lobectomy for lung cancer. He underwent robot-assisted carina resection and reconstruction under spontaneous-ventilation anesthesia via single-lumen endotracheal intubation. CASE PRESENTATION: A 58-year-old male presented with a malignant tracheal carina tumor, complaining of bloody sputum and progressive dyspnea. Chest computed tomography (CT) and bronchoscopic biopsy confirmed squamous cell carcinoma. The patient had undergone right middle and lower lobectomy for squamous cell carcinoma (pT2bN0M0) two years prior. Current diagnosis was local recurrence with 90% carinal obstruction. After two cycles of chemoimmunotherapy, his symptoms resolved, and chest CT indicated near-complete remission (cCR). One month post-treatment, he underwent robot-assisted thoracoscopic carina resection under spontaneous-ventilation anesthesia with single-lumen intubation. After anesthesia induction, surface infiltration anesthesia was performed on the glottis, trachea, carina, and main bronchus under the guidance of fiberbronchoscope, and a 7.0# single-lumen tube was placed. Regional block was performed on the incision site, vagus nerve, and intercostal nerves, followed by lidocaine spray on the lung surface. Spontaneous breathing was maintained using synchronized intermittent mandatory ventilation plus pressure support ventilation (P-SIMV) followed by spontaneous mode. During carinal resection, a suction tube was inserted into the left main bronchus for oxygen insufflation. The procedure was completed with stable spontaneous ventilation and no air leak. The patient was extubated immediately post-operation, monitored briefly in the ICU, and transferred to the ward. This approach yielded excellent clinical outcomes. CONCLUSION: Single-lumen endotracheal intubation with preserved spontaneous-ventilation anesthesia for robot-assisted tracheal carina resection and reconstruction is safe and feasible. Compared with laryngeal mask spontaneous-ventilation anesthesia, this method has a wider range of applications among patients and is worthy of promotion and application.