Airway management and one-lung ventilation strategies during hepatic histotripsy: a retrospective service evaluation from a single institution in Hong Kong.

This retrospective single-centre service evaluation describes double-lumen tube one-lung ventilation as a respiratory motion-control strategy for hepatic histotripsy in 26 adults in Hong Kong. Histotripsy is a non-invasive, non-thermal focused ultrasound technique requiring precise targeting, challenged by respiratory-induced liver motion. High-frequency jet ventilation has been used to minimise motion but carries practical and physiological limitations. All procedures were performed under general anaesthesia with intended double-lumen tube one-lung ventilation. Successful double-lumen tube placement without modification was achieved in 81% of cases; overall, 92% of patients received one-lung ventilation using either double-lumen tube or bronchial blockers. Transient intra-operative desaturation occurred in 29% of one-lung ventilation cases but was managed with standard ventilatory adjustments. Technical success was achieved in 92% of cases. No major airway or respiratory complications or unplanned critical care admissions occurred and all patients were discharged within 2 days postoperatively. These findings suggest that double-lumen tube one-lung ventilation is a feasible and safe alternative to high-frequency jet ventilation for respiratory motion control during hepatic histotripsy, using widely available thoracic anaesthesia techniques. The retrospective design, small sample size and absence of comparator group highlight the need for future prospective trials to evaluate efficacy, safety and cost-effectiveness relative to high-frequency jet ventilation.