Minimally invasive neck surgery. Surgical feasibility and physiological effects of carbon dioxide insufflation in a unilateral subplatysmal approach

Endoscopically assisted, minimally invasive techniques to regions without a natural cavity require insufflation with carbon dioxide (CO2). In the neck region this may impair hemodynamics, blood gas homoeostasis, cerebral blood circulation and increase the intracranial pressure. An exclusively endoscopic unilateral subplatysmal approach to the submandibular region was investigated in nine mini-pigs randomized to three groups. On both neck sides, within a 14 day interval, the subplatysmal space was inflated with CO2 at 10 mmHg, 20 mmHg (1.33/2.66 x 103Pa) or 20 mmHg (2.66 x 103Pa) combined with mechanical suspension. Data for hemodynamic and blood gas parameters, gas volumes, and intracranial pressure were obtained preoperatively, 30 min after onset and 10 min postopeatively. In a pocket created by insufflation of 20 mmHg (2.66 x 103Pa), exposition and resection of the submandibular gland were accomplished easily. The elevation procedure had technical disadvantages. The mean operation time was 48.9 min. Unilateral subplatysmal carbon dioxide insufflation of the submandibular neck region up to 20 mmHg (2.66 x 103Pa) did not affect physiological parameters. As an exclusive endoscopical approach for unilateral surgery of the submandibular region, the use of inflation pressures of up to 20 mmHg (2.66 x 103Pa) might be considered.