Complex airway surgery, particularly tracheal/carinal resection and reconstruction, is still considered as the “crown jewel” of video-assisted thoracoscopic surgery (VATS). Notably, during these procedures, maintaining adequate oxygenation and preventing hypercapnia, while simultaneously ensuring optimal surgical conditions, remains a formidable challenge. Drawing on prior clinical experience, successful airway surgery hinges on close collaboration with a skilled anesthesia team, where the choice of ventilation mode—intubated or non-intubated (tubeless)—plays a critical role in achieving optimal procedural outcomes.
In a comparative study, Prof. He’s team successfully performed thoracoscopic carinal (4 patients) and tracheal (14 patients) resections under the HE Breathing ventilation mode, achieving shorter anastomosis times (22.5–40 vs. 45–86 minutes), operative duration (162.5 vs. 260 minutes) and potentially postoperative hospital stays (11.5±4.3 vs. 13.2±6.3 days), compared with the conventional intubated ventilation method. These results underscore the significant advantages of HE Breathing ventilation mode in enhancing surgical safety, reducing perioperative mortality and promoting faster recovery. Key contributing factors include:
With the collaborative efforts of surgeons and anesthesiologists, HE Breathing ventilation mode has emerged as an innovative technique in airway surgery, offering significant advantages. Further investigations into its respiratory dynamics and other underlying mechanisms are warranted. Prof. He’s team has successfully extended its application to robotic-assisted VATS, and it is anticipated that this technique will achieve broader adoption and benefit a wider range of patients in the future.
Journal of Thoracic Disease
Commentary/editorial
People
HE Breathing: a new ventilation mode in airway surgery
28-Dec-2024
All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-1308/coif). J.H. serves as the Executive Editor-in-Chief of Journal of Thoracic Disease. The other authors have no conflicts of interest to declare.