{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T10:30:21Z","timestamp":1760956221816,"version":"3.37.3"},"reference-count":15,"publisher":"Wiley","license":[{"start":{"date-parts":[[2017,1,1]],"date-time":"2017-01-01T00:00:00Z","timestamp":1483228800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Case Reports in Surgery"],"published-print":{"date-parts":[[2017]]},"abstract":"<jats:p>Robotic surgery with carbon dioxide (CO<jats:sub>2<\/jats:sub>) insufflation to the thorax is frequently performed to gain a better operative field of view, although its intraoperative complications have not yet been discussed in detail. We treated two patients with difficult ventilation caused by distal migration of a double-lumen endotracheal tube (DLT) during robotic thymectomy. In the first case, migration of the DLT during one-lung ventilation (OLV) occurred after CO<jats:sub>2<\/jats:sub> insufflation to the bilateral thoraxes was started. Oxygenation rapidly deteriorated because dependent lung expansion was restricted by CO<jats:sub>2<\/jats:sub> insufflation. In the second case, migration of the DLT during OLV occurred while CO<jats:sub>2<\/jats:sub> insufflation to a unilateral thorax and mediastinum was performed. In both cases, once migration of the DLT during OLV occurred with CO<jats:sub>2<\/jats:sub> insufflation, readjusting the DLT became very difficult because our manipulation of bronchofiberscopy was prevented by the robot arms located above the patient\u2019s head and because deformation of the trachea\/bronchus induced by CO<jats:sub>2<\/jats:sub> insufflation caused a poor image of the bronchofiberscopic view. Thus, during robotic-assisted thoracoscopic surgery with CO<jats:sub>2<\/jats:sub> insufflation, since there is a potential risk of difficult ventilation with a DLT and since readjustment of the DLT is very difficult, discontinuing CO<jats:sub>2<\/jats:sub> insufflation and switching to double-lung ventilation are needed in such a situation.<\/jats:p>","DOI":"10.1155\/2017\/3403045","type":"journal-article","created":{"date-parts":[[2017,4,26]],"date-time":"2017-04-26T17:08:01Z","timestamp":1493226481000},"page":"1-5","source":"Crossref","is-referenced-by-count":0,"title":["Difficult Management of a Double-Lumen Endotracheal Tube and Difficult Ventilation during Robotic Thymectomy with Carbon Dioxide Insufflation"],"prefix":"10.1155","volume":"2017","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6023-582X","authenticated-orcid":true,"given":"Yuki","family":"Sugiyama","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Resuscitology, Shinshu University School 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