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Background Thoracoscopic esophagectomy in the prone position has been introduced with the intent of minimizing thoracotomy-related complications, technical challenges of the traditional left lateral decubitus thoracoscopy, and respiratory impairment resulting from double-lumen intubation. The aim of this study was to evaluate the effects of prone thoracoscopic esophagectomy with single-lumen intubation on ventilation, respiratory gas exchange, and cardiovascular parameters.Materials and methodsFrom September 2007 to August 2008, 32 consecutive patients underwent prone thoracoscopic esophagectomy (n=16) or an Ivor-Lewis esophagectomy (n=16). Immediately before surgery patients were sampled for arterial blood and central venous blood; cardiac index during spontaneous respiration was also calculated.Ventilation and cardiovascular parameters were measured before and during anesthesia induction, every 15 minutes during the operation, and 1 hour after extubation. True pulmonary shunt fraction was calculated from saturation and partial oxygen pressures in arterial and central venous blood samples. ResultsPatients undergoing prone thoracoscopic esophagectomy showed higher oxygenation levels compared to the thoracotomy group (mean PaO2/Fio2= 390 7±33,6 mmHg vs. 151,8±36,4 S.D mmHg respectively, p<0.001). Mean pulmonary shunt fraction was significantly lower in patients undergoing prone thoracoscopy compared to those who had right lateral thoracotomy (22,7%±5,7S.D. vs. 35,0%±7,0S.D p=0.001). There was no significant difference in the cardiovascular parameters or in the postoperative morbidity. ConclusionsProne thoracoscopy during the thoracic phase of esophagectomy lead to a significantly better global oxygen delivery and lowered the pulmonary shunt when compared to thoracotomy.