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Che W, Zhong J, Huang J, Chen H, Feng C, Xie Y, He H, Chen Y, Li C, Wu B, Ding W, Lin W. Minimally invasive esophagectomy with non-invasive ventilation by laryngeal mask-assisted anesthesia for esophageal squamous cell carcinoma: case report. Front Oncol 2024; 14:1344662. [PMID: 38800373 PMCID: PMC11116687 DOI: 10.3389/fonc.2024.1344662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 04/08/2024] [Indexed: 05/29/2024] Open
Abstract
Minimally invasive esophagectomy for cancer surgery remains associated with significant morbidity and surgical complications across the globe. Non-intubation video-assisted thoracic surgery (NIVATS) has been successfully employed in lung resection in recent years, but there are few reported cases with regard to the safety and feasibility of this approach in radical esophagectomy for patients with esophageal cancers. We present 4 consecutive cases with esophageal squamous cell carcinoma (ESCC) who received minimally invasive McKeown's esophagectomy under non-intubation general anesthesia from November 2022 to April 2023. All these patients were aged from 55 to 75 years old and were pathologically diagnosed with ESCC. All procedures of McKeown's esophagectomy in these patients were completed with non-invasive ventilation by laryngeal mask-assisted anesthesia. Operation duration ranged from 185 to 395 minutes and the estimated blood loss ranged from 25 to 60 ml in these 4 cases. No severe hypoxia was observed and transient hypercapnia was resolved intraoperatively. None of them was converted to endotracheal intubation with mechanical ventilation or to thoracotomy. The number of retrieved lymph nodes in mediastinum were 21-27 and all patients received R0 surgery with pathological stage as T1bN0M0 to T3N2M0. There was no serious complication (Clavien-Dindo grade III-IV) observed perioperatively and they were all discharged 11-14 days after the surgery with resumption of oral feeding. They are all alive without tumor recurrence at the date of data collection. The safety and efficacy of minimally invasive esophagectomy with non-invasive ventilation by laryngeal mask-assisted anesthesia for patients with ESCC are warranted for explored in a larger cohort study.
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Affiliation(s)
- Weibi Che
- Department of Thoracic Surgery, Gaozhou People’s Hospital, Guangdong, China
| | - Jian Zhong
- Department of Thoracic Surgery, Gaozhou People’s Hospital, Guangdong, China
| | - Jiawei Huang
- Department of Thoracic Surgery, Gaozhou People’s Hospital, Guangdong, China
| | - Huilong Chen
- Department of Thoracic Surgery, Gaozhou People’s Hospital, Guangdong, China
| | - Caihou Feng
- Department of Thoracic Surgery, Gaozhou People’s Hospital, Guangdong, China
| | - Yujie Xie
- Department of Thoracic Surgery, Gaozhou People’s Hospital, Guangdong, China
| | - Haiquan He
- Department of Thoracic Surgery, Gaozhou People’s Hospital, Guangdong, China
| | - Ying Chen
- Department of Thoracic Surgery, Gaozhou People’s Hospital, Guangdong, China
| | - Cui Li
- Department of Thoracic Surgery, Gaozhou People’s Hospital, Guangdong, China
| | - Bomeng Wu
- Department of Thoracic Surgery, Gaozhou People’s Hospital, Guangdong, China
| | - Wei Ding
- Department of Anesthesiology, Gaozhou People’s Hospital, Guangdong, China
| | - Wanli Lin
- Department of Thoracic Surgery, Gaozhou People’s Hospital, Guangdong, China
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Szabo Z, Fabo C, Szarvas M, Matuz M, Oszlanyi A, Farkas A, Paroczai D, Lantos J, Furak J. Spontaneous Ventilation Combined with Double-Lumen Tube Intubation during Thoracic Surgery: A New Anesthesiologic Method Based on 141 Cases over Three Years. J Clin Med 2023; 12:6457. [PMID: 37892595 PMCID: PMC10607362 DOI: 10.3390/jcm12206457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Non-intubated thoracic surgery has not achieved widespread acceptance despite its potential to improve postoperative outcomes. To ensure airway safety, our institute has developed a technique combining spontaneous ventilation with double-lumen tube intubation (SVI). This study aimed to verify the feasibility and limitations of this SVI technique. METHODS For the SVI method, anesthesia induction involves fentanyl and propofol target-controlled infusion, with mivacurium administration. Bispectral index monitoring was used to ensure the optimal depth of anesthesia. Short-term muscle relaxation facilitated double-lumen tube intubation and early surgical steps. Chest opening preceded local infiltration, followed by a vagal nerve blockade to prevent the cough reflex and a paravertebral blockade for pain relief. Subsequently, the muscle relaxant was ceased. The patient underwent spontaneous breathing without coughing during surgical manipulation. RESULTS Between 10 March 2020 and 28 October 2022, 141 SVI surgeries were performed. Spontaneous respiration with positive end-expiratory pressure was sufficient in 65.96% (93/141) of cases, whereas 31.21% (44/141) required pressure support ventilation. Only 2.84% (4/141) of cases reversed to conventional anesthetic management, owing to technical or surgical difficulties. Results of the 141 cases: The mean maximal carbon dioxide pressure was 59.01 (34.4-92.9) mmHg, and the mean lowest oxygen saturation was 93.96% (81-100%). The mean one-lung, mechanical and spontaneous one-lung ventilation time was 74.88 (20-140), 17.55 (0-115) and 57.73 (0-130) min, respectively. CONCLUSIONS Spontaneous ventilation with double-lumen tube intubation is safe and feasible for thoracic surgery. The mechanical one-lung ventilation time was reduced by 76.5%, and the rate of anesthetic conversion to relaxation was low (2.8%).
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Affiliation(s)
- Zsolt Szabo
- Doctoral School of Multidisciplinary Medicine, University of Szeged, H-6720 Szeged, Hungary
| | - Csongor Fabo
- Department of Anesthesiology and Intensive Therapy, University of Szeged, H-6720 Szeged, Hungary
| | - Matyas Szarvas
- Department of Anesthesiology and Intensive Therapy, University of Szeged, H-6720 Szeged, Hungary
| | - Maria Matuz
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, H-6720 Szeged, Hungary
| | - Adam Oszlanyi
- Department of Anesthesiology and Intensive Therapy, Bács-Kiskun County Teaching Hospital, H-6000 Kecskemét, Hungary
| | - Attila Farkas
- Department of Thoracic Surgery, Markusovszky University Teaching Hospital, H-9700 Szombathely, Hungary
| | - Dora Paroczai
- Department of Medical Microbiology, University of Szeged, H-6720 Szeged, Hungary
| | - Judit Lantos
- Department of Neurology, Bács-Kiskun County Teaching Hospital, H-6000 Kecskemét, Hungary
| | - Jozsef Furak
- Department of Surgery, University of Szeged, H-6720 Szeged, Hungary
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Huang APH, Tsai FF, Chen CC, Lee TS, Kuo LT. Feasibility of Nonintubated Anesthesia for Lumboperitoneal Shunt Implantation. Clin Pract 2022; 12:449-456. [PMID: 35735668 PMCID: PMC9221739 DOI: 10.3390/clinpract12030049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 05/30/2022] [Accepted: 06/09/2022] [Indexed: 11/16/2022] Open
Abstract
Lumboperitoneal shunt (LPS) implantation is a cerebrospinal fluid diversion therapy for the communicating type of normal-pressure hydrocephalus (NPH); NPH mainly affects older adults. However, endotracheal intubation for mechanical ventilation with muscle relaxant increases perioperative and postoperative risks for this population. Based on knowledge from nonintubated thoracoscopic surgery, which has been widely performed in recent years, we describe a novel application of nonintubated anesthesia for LPS implantation in five patients. Anesthesia without muscle relaxants, with a laryngeal mask in one patient and a high-flow nasal cannula in four patients, was used to maintain spontaneous breathing during the surgery. The mean anesthesia time was 103.8 min, and the mean operative duration was 55.8 min. All patients recovered from anesthesia uneventfully. In our experience, nonintubated LPS surgery appears to be a promising and safe surgical technique for appropriately selected patients with NPH.
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Affiliation(s)
- Abel Po-Hao Huang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan;
| | - Feng-Fang Tsai
- Department of Anesthesiology, National Taiwan University Hospital, Taipei 100, Taiwan; (F.-F.T.); (T.-S.L.)
| | - Chien-Chia Chen
- Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan;
| | - Tzong-Shiun Lee
- Department of Anesthesiology, National Taiwan University Hospital, Taipei 100, Taiwan; (F.-F.T.); (T.-S.L.)
| | - Lu-Ting Kuo
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan;
- Correspondence: ; Tel.: +886-2-2312-3456
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Furák J, Németh T, Lantos J, Fabó C, Géczi T, Zombori-Tóth N, Paróczai D, Szántó Z, Szabó Z. Perioperative Systemic Inflammation in Lung Cancer Surgery. Front Surg 2022; 9:883322. [PMID: 35669251 PMCID: PMC9163434 DOI: 10.3389/fsurg.2022.883322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/02/2022] [Indexed: 12/05/2022] Open
Abstract
Systemic inflammation (SI) is a response of the immune system to infectious or non-infectious injuries that defends the body homeostasis. Every surgical intervention triggers SI, the level of which depends on the extent of damage caused by the surgery. During the first few hours after the damage, the innate or natural immunity, involving neutrophils, macrophages, and natural killer cells, plays a main role in the defense mechanism, but thereafter the adaptive immune response ensues. The number of leukocytes is elevated, the levels of lymphocytes and natural killer cells are reduced, and the cytokines released after surgery correlate with surgical damage. Minimally invasive thoracic surgery procedures induce less inflammatory response and reduce the immune defense in patients to a more moderate level compared with the open surgery procedures; this immunosuppression can be further diminished in spontaneous ventilation cases. The normal functioning of the immune defense is important in controlling the perioperative circulatory tumor cells. Moreover, elevated levels of inflammatory cytokines before immune therapy have a negative impact on the response, and significantly shorten the progression-free survival. Clinically, the lower are the levels of cytokines released during lung surgery, the lesser is the postoperative morbidity, especially pneumonia and wound infection. The return to normal levels of lymphocytes and cytokines occurs faster after spontaneous ventilation surgery. The use of locoregional anesthesia can also reduce SI. Herein, we review the current knowledge on the effects of different operative factors on postoperative SI and defense mechanism in lung cancer surgery.
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Affiliation(s)
- József Furák
- Department of Surgery, Faculty of Medicine, University of Szeged, Szeged, Hungary
- Correspondence: József Furák
| | - Tibor Németh
- Department of Surgery, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Judit Lantos
- Department of Neurology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Csongor Fabó
- Department of Anesthesiology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Tibor Géczi
- Department of Surgery, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Noémi Zombori-Tóth
- Department of Pathology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Dóra Paróczai
- Department of Medical Microbiology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Zalán Szántó
- Department of Thoracic Surgery. Medical School, University of Pécs, Pécs, Hungary
| | - Zsolt Szabó
- Institute of Surgical Research, Faculty of Medicine, University of Szeged, Szeged, Hungary
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Rosboch GL, Lyberis P, Ceraolo E, Balzani E, Cedrone M, Piccioni F, Ruffini E, Brazzi L, Guerrera F. The Anesthesiologist's Perspective Regarding Non-intubated Thoracic Surgery: A Scoping Review. Front Surg 2022; 9:868287. [PMID: 35445075 PMCID: PMC9013756 DOI: 10.3389/fsurg.2022.868287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/24/2022] [Indexed: 12/24/2022] Open
Abstract
Non-intubated thoracic surgery (NITS) is a growing practice, alongside minimally invasive thoracic surgery. To date, only a consensus of experts provided opinions on NITS leaving a number of questions unresolved. We then conducted a scoping review to clarify the state of the art regarding NITS. The systematic review of all randomized and non-randomized clinical trials dealing with NITS, based on Pubmed, EMBASE, and Scopus, retrieved 665 articles. After the exclusion of ineligible studies, 53 were assessed examining: study type, Country of origin, surgical procedure, age, body mass index, American Society of Anesthesiologist's physical status, airway management device, conversion to orotracheal intubation and pulmonary complications rates and length of hospital stay. It emerged that NITS is a procedure performed predominantly in Asia, and certain European Countries. In China, NITS is more frequently performed for parenchymal resection surgery, whereas in Europe, it is mainly employed for pleural pathologies. The most commonly used device for airway management is the laryngeal mask. The conversion rate to orotracheal intubation is a~3%. The results of the scoping review seem to suggest that NITS procedures are becoming increasingly popular, but its role needs to be better defined. Further randomized clinical trials are needed to better define the role of the clinical variables possibly impacting on the technique effectiveness.Systematic Review Registrationhttps://osf.io/mfvp3/, identifier: 10.17605/OSF.IO/MFVP3.
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Affiliation(s)
- Giulio Luca Rosboch
- Department of Anesthesia, Intensive Care and Emergency, “Città della Salute e della Scienza di Torino” Hospital, Torino, Italy
- *Correspondence: Giulio Luca Rosboch
| | - Paraskevas Lyberis
- Department of Cardiovascular and Thoracic Surgery, “Città della Salute e della Scienza di Torino” Hospital, Torino, Italy
| | - Edoardo Ceraolo
- Department of Anesthesia, Intensive Care and Emergency, “Città della Salute e della Scienza di Torino” Hospital, Torino, Italy
| | - Eleonora Balzani
- Department of Surgical Science, University of Turin, Torino, Italy
| | - Martina Cedrone
- Department of Surgical Science, University of Turin, Torino, Italy
| | - Federico Piccioni
- Anesthesia and Intensive Care Unit, General and Specialistic Surgical Department, Arcispedale Santa Maria Nuova, Azienda USL – IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Enrico Ruffini
- Department of Cardiovascular and Thoracic Surgery, “Città della Salute e della Scienza di Torino” Hospital, Torino, Italy
- Department of Surgical Science, University of Turin, Torino, Italy
| | - Luca Brazzi
- Department of Anesthesia, Intensive Care and Emergency, “Città della Salute e della Scienza di Torino” Hospital, Torino, Italy
- Department of Surgical Science, University of Turin, Torino, Italy
| | - Francesco Guerrera
- Department of Cardiovascular and Thoracic Surgery, “Città della Salute e della Scienza di Torino” Hospital, Torino, Italy
- Department of Surgical Science, University of Turin, Torino, Italy
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Wang R, Wang Q, Jiang S, Chen C, Zheng J, Liu H, Liang X, Chen Z, Wang H, Guo Z, Liang W, He J, Liang H, Wang W. Spontaneous Ventilation Video-Assisted Thoracoscopic Surgery for Non-small-cell Lung Cancer Patients With Poor Lung Function: Short- and Long-Term Outcomes. Front Surg 2022; 9:800082. [PMID: 35310434 PMCID: PMC8928927 DOI: 10.3389/fsurg.2022.800082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe goal of this study was to explore the feasibility and safety of spontaneous ventilation video-assisted thoracoscopic surgery (SV-VATS) for non-small-cell lung cancer (NSCLC) patients with poor lung function.MethodsNSCLC patients with poor lung function who underwent SV-VATS or mechanical ventilation VATS (MV-VATS) from 2011 to 2018 were analyzed. 1:2 Propensity score matching (PSM) was applied, and the short- and long-term outcomes between the SV-VATS group and the MV-VATS group were compared.ResultsAnesthesia time (226.18 ± 64.89 min vs. 248.27 ± 76.07 min; P = 0.03), operative time (140.85 ± 76.07 min vs. 163.12 ± 69.37 min; P = 0.01), days of postoperative hospitalization (7.29 ± 3.35 days vs. 8.40 ± 7.89 days; P = 0.04), and days of chest tube use (4.15 ± 2.89 days vs. 5.15 ± 3.54 days; P = 0.01), the number of N1 station lymph node dissection (2.94 ± 3.24 vs. 4.34 ± 4.15; P = 0.005) and systemic immune-inflammation index (3855.43 ± 3618.61 vs. 2908.11 ± 2933.89; P = 0.04) were lower in SV-VATS group. Overall survival and disease-free survival were not significantly different between the two groups (OS: HR 0.66, 95% CI: 0.41–1.07, P = 0.09; DFS: HR 0.78, 95% CI: 0.42–1.45, P = 0.43).ConclusionsComparable short-term and long-term outcomes indicated that SV-VATS is a feasible and safe method and might be an alternative to MV-VATS when managing NSCLC patients with poor lung function.
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Affiliation(s)
- Runchen Wang
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Qixia Wang
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Shunjun Jiang
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chao Chen
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Jianqi Zheng
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hui Liu
- Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xueqing Liang
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Zhuxing Chen
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Haixuan Wang
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhuoxuan Guo
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenhua Liang
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianxing He
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Hengrui Liang
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- *Correspondence: Hengrui Liang
| | - Wei Wang
- State Key Laboratory of Respiratory Disease, Department of Thoracic Surgery and Oncology, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Wei Wang
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Wang ML, Hung MH, Hsu HH, Cheng YJ, Chen JS. Non-intubated Thoracoscopic Surgery to Minimize Contamination From Airway Secretions During the COVID-19 Pandemic. Front Surg 2022; 9:818824. [PMID: 35252335 PMCID: PMC8894440 DOI: 10.3389/fsurg.2022.818824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/27/2022] [Indexed: 01/08/2023] Open
Abstract
Background General anesthesia and tracheal intubation potentially pose a high risk to health care workers (HCWs) managing surgical patients during the coronavirus disease 2019 (COVID-19) pandemic. Non-intubated anesthesia is a rational way of managing patients undergoing thoracoscopic surgery that avoids tracheal intubation and minimizes the aerosols generated during airway instrumentation. The purpose of this study was to determine whether non-intubated anesthesia in combination with a face mask is safe and feasible in patients undergoing thoracoscopic surgery. Methods A total of 18 patients who underwent non-intubated thoracoscopic surgery with a face mask during the perioperative period between March 9, 2020 and April 6, 2020 were included. The main outcomes were anesthetic management and postoperative results. Results The 18 patients had a mean age of 64 years and a body mass index of 22.9 kg/m2. All patients wore a mask during induction of anesthesia and throughout surgery. Three patients underwent lobectomy, four segmentectomy, ten wedge resection, and one underwent anterior mediastinal tumor resection. No patient developed cough or vomiting during the perioperative period. All patients were transferred to the postoperative recovery unit within 15 min of the end of surgery (average 7.2 min). No patient required conversion to tracheal intubation or conversion to thoracotomy. Conclusion Non-intubated anesthesia with a mask was safe and feasible in patients undergoing thoracoscopic surgery. Avoidance of intubated general anesthesia and use of a lung separation device may reduce the risk to HCWs of contamination by airway secretions, thereby conserving personal protective equipment, especially during the COVID-19 pandemic.
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Affiliation(s)
- Man-Ling Wang
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ming-Hui Hung
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsao-Hsun Hsu
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ya-Jung Cheng
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Anesthesiology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Jin-Shing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
- *Correspondence: Jin-Shing Chen
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8
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Better intraoperative cardiopulmonary stability and similar postoperative results of spontaneous ventilation combined with intubation than non-intubated thoracic surgery. Gan To Kagaku Ryoho 2022; 70:559-565. [PMID: 34985733 DOI: 10.1007/s11748-021-01768-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/23/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Non-intubated spontaneous ventilation video-assisted thoracic surgery lobectomy is a well-known procedure, but there are doubts regarding its safety. To solve this problem, we developed a safe procedure for spontaneous ventilation thoracic surgery (spontaneous ventilation with intubation). This study analyzed the intraoperative parameters and postoperative results of spontaneous ventilation with intubation. METHODS Between March 11, 2020 and March 26, 2021, 38 spontaneous ventilation with intubation video-assisted thoracic surgery lobectomies were performed. We chose the first 38 non-intubated spontaneous ventilation video-assisted thoracic surgery lobectomy cases with a laryngeal mask performed in 2017 for comparison. RESULTS There were no significant differences between the non-intubated spontaneous ventilation and spontaneous ventilation with intubation groups in postoperative surgical results (surgical time: 98,7 vs. 88,1 min (p = 0.067); drainage time: 3.5 vs. 2.7 days (p = 0.194); prolonged air leak 15.7% vs. 10.5% (p = 0.5); conversion rate to relaxation: 5.2% vs. 13.1% (p = 0.237); failure of the spontaneous ventilation rate: 10.5% vs. 13.1% (p = 0.724); and morbidity: 21% vs. 13.1% (p = 0.364)) and oncological outcomes. Significantly lower lowest systolic and diastolic blood pressure (systolic, 83.1 vs 132.3 mmHg, p = 0.001; diastolic 47.8 vs. 73.4 mmHg, p = 0.0001), lowest oxygen saturation (90.3% vs 94.9%, p = 0.026), and higher maximum pCO2 level (62.5 vs 54.8 kPa, p = 0.009) were found in the non-intubated spontaneous ventilation group than in the spontaneous ventilation with intubation group. CONCLUSIONS Spontaneous ventilation with intubation is a more physiological procedure than non-intubated spontaneous ventilation in terms of intraoperative blood pressure stability and gas exchange. The surgical results were similar in the two groups.
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Grott M, Eichhorn M, Eichhorn F, Schmidt W, Kreuter M, Winter H. Thoracic surgery in the non-intubated spontaneously breathing patient. Respir Res 2022; 23:379. [PMID: 36575519 PMCID: PMC9793515 DOI: 10.1186/s12931-022-02250-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 11/12/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The interest in non-intubated video-assisted thoracic surgery (NIVATS) has risen over the last decade and numerous terms have been used to describe this technique. They all have in common, that the surgical procedure is performed in a spontaneously breathing patient under locoregional anaesthesia in combination with intravenous sedation but have also been performed on awake patients without sedation. Evidence has been generated favouring NIVATS compared to one-lung-ventilation under general anaesthesia. MAIN BODY We want to give an overview of how NIVATS is performed, and which different techniques are possible. We discuss advantages such as shorter length of hospital stay or (relative) contraindications like airway difficulties. Technical aspects, for instance intraoperative handling of the vagus nerve, are considered from a thoracic surgeon's point of view. Furthermore, special attention is paid to the cohort of patients with interstitial lung diseases, who seem to benefit from NIVATS due to the avoidance of positive pressure ventilation. Whenever a new technique is introduced, it must prove noninferiority to the state of the art. Under this aspect current literature on NIVATS for lung cancer surgery has been reviewed. CONCLUSION NIVATS technique may safely be applied to minor, moderate, and major thoracic procedures and is appropriate for a selected group of patients, especially in interstitial lung disease. However, prospective studies are urgently needed.
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Affiliation(s)
- Matthias Grott
- grid.5253.10000 0001 0328 4908Department of Thoracic Surgery, Thoraxklinik, University Hospital Heidelberg, Roentgenstrasse 1, 69126 Heidelberg, Germany ,Translational Lung Research Centre Heidelberg (TLRC-H), German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Martin Eichhorn
- grid.5253.10000 0001 0328 4908Department of Thoracic Surgery, Thoraxklinik, University Hospital Heidelberg, Roentgenstrasse 1, 69126 Heidelberg, Germany ,Translational Lung Research Centre Heidelberg (TLRC-H), German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Florian Eichhorn
- grid.5253.10000 0001 0328 4908Department of Thoracic Surgery, Thoraxklinik, University Hospital Heidelberg, Roentgenstrasse 1, 69126 Heidelberg, Germany ,Translational Lung Research Centre Heidelberg (TLRC-H), German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Werner Schmidt
- grid.5253.10000 0001 0328 4908Department of Anaesthesiology and Intensive Care Medicine, Thoraxklinik, University Hospital Heidelberg, Roentgenstrasse 1, 69126 Heidelberg, Germany
| | - Michael Kreuter
- Translational Lung Research Centre Heidelberg (TLRC-H), German Centre for Lung Research (DZL), Heidelberg, Germany ,grid.5253.10000 0001 0328 4908Center for Interstitial and Rare Lung Diseases, Pneumology Thoraxklinik, University Hospital Heidelberg, Roentgenstrasse 1, 69126 Heidelberg, Germany
| | - Hauke Winter
- grid.5253.10000 0001 0328 4908Department of Thoracic Surgery, Thoraxklinik, University Hospital Heidelberg, Roentgenstrasse 1, 69126 Heidelberg, Germany ,Translational Lung Research Centre Heidelberg (TLRC-H), German Centre for Lung Research (DZL), Heidelberg, Germany
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10
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Xu Q, Mo X, Xiong J, Zhang Y. Case Report: Discontinuous Spontaneous Ventilating Anesthesia for McKeown Esophagectomy by Laryngeal Mask: A Case Series-A Novel Approach of Discontinuous Spontaneous Ventilating Anesthesia for Esophagectomy. Front Surg 2021; 8:783859. [PMID: 34957206 PMCID: PMC8696255 DOI: 10.3389/fsurg.2021.783859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
Double lumen endobronchial ventilation in McKeown esophagectomy is common for esophageal cancer. In spite of most patients could be extubated immediately after surgery under adequate multimodal analgesia, still some patients require extended mechanical ventilation or airway support post-surgery because of pain or difficult respiration. The present study reported a novel challenge for McKeown esophagectomy with discontinuous spontaneous ventilating anesthesia by the laryngeal mask. Three esophageal cancer patients underwent McKeown esophagectomy under discontinuous spontaneous ventilating anesthesia with local and regional analgesia and appropriate sedation. Two of them were accomplished under non-intubated video-assisted thoracoscopic surgery (NIVATS), and then, the abdominal and neck surgery was managed under laryngeal mask airway with appropriate muscle relaxation. One patient was endured high PetCO2 level, and converted to regular double lumen endobronchial intubation for safety. However, from the two successful cases, we still proved that the discontinuous spontaneous ventilating anesthesia achieved the same anesthetic effect as bronchial intubation under general anesthesia for McKeown esophagectomy, which reduced the postoperative pharyngeal discomfort, might be beneficial to the patients for enhanced recovery after surgery (ERAS).
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Affiliation(s)
- Qiaoqiao Xu
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong Science and Technology University, Wuhan, China
| | - Xuan Mo
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong Science and Technology University, Wuhan, China
| | - Juan Xiong
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong Science and Technology University, Wuhan, China
| | - Yi Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong Science and Technology University, Wuhan, China
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11
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Zheng J, Liang H, Wang R, Zhong R, Jiang S, Wang W, Zhao Y, Chen Z, Liang W, Liu J, He J. Perioperative and long-term outcomes of spontaneous ventilation video-assisted thoracoscopic surgery for non-small cell lung cancer. Transl Lung Cancer Res 2021; 10:3875-3887. [PMID: 34858778 PMCID: PMC8577985 DOI: 10.21037/tlcr-21-629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/24/2021] [Indexed: 12/17/2022]
Abstract
Background Spontaneous ventilation video-assisted thoracoscopic surgery (SV-VATS) exhibits dual intraoperative and postoperative advantages for patients with non-small cell lung cancer (NSCLC). However, there is a lack of data regarding its long-term survival superiority over the double-lumen intubated mechanical ventilation video-assisted thoracoscopic surgery (MV-VATS) or thoracotomy. Methods A retrospective study was conducted from 2011 to 2018 in the First Affiliated Hospital of Guangzhou Medical University among patients with NSCLC who underwent the SV-VATS or the MV-VATS. Patients receiving the SV-VATS were the study group, and patients receiving the MV-VATS were the control group. Propensity score matching (PSM) was performed to establish 1:1 SV-VATS versus MV-VATS group matching to balance potential baseline confounding factors. Primary endpoints were overall survival (OS) and disease-free survival (DFS). Secondary endpoints were perioperative outcomes. The baseline information of these patients was recorded. The perioperative data and survival data were collected using a combination of electronic data record system and telephone interview. A 1:1:1 SPM was also used to compare the OS in the SV-VATS, the MV-VATS and thoracotomy group by using another database, including patients undergoing thoracotomy and the MV-VATS. Results For the two-group comparison, after 1:1 PSM, a matched cohort with 400 (200:200) patients was generated. The median follow-up time in this cohort was 4.78 years (IQR, 3.78–6.62 years). The OS (HR =0.567, 95% CI, 0.330 to 0.974, P=0.0498) and the DFS (HR =0.546, 95% CI, 0.346 to 0.863, P=0.013) of the SV-VATS group were significantly better than the MV-VATS group. There were no statistically differences between the SV-VATS and the MV-VATS group on the operative time (158.56±40.09 vs. 172.06±61.75, P=0.200) anesthesia time (247.4±62.49 vs. 256.7±58.52, P=0.528), and intraoperative bleeding volume (78.88±80.25 vs. 109.932±180.86, P=0.092). For the three-group comparison, after 1:1:1 PSM, 582 (194:194:194) patients were included for the comparison of SV-VATS, MV-VATS and thoracotomy. The OS of the SV-VATS group was significantly better than the thoracotomy group (HR =0.379, 95% CI, 0.233 to 0.617, P<0.001). Conclusions Invasive NSCLC patients undergoing SV-VATS lobectomy demonstrated better long-term outcomes compared with MV-VATS.
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Affiliation(s)
- Jianqi Zheng
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Hengrui Liang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Runchen Wang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.,Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Ran Zhong
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Shunjun Jiang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Wei Wang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Yi Zhao
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Zhuxing Chen
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jun Liu
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.,Nanshan School, Guangzhou Medical University, Guangzhou, China
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12
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Chiang XH, Lin MW. Converting to Intubation During Non-intubated Thoracic Surgery: Incidence, Indication, Technique, and Prevention. Front Surg 2021; 8:769850. [PMID: 34765639 PMCID: PMC8576186 DOI: 10.3389/fsurg.2021.769850] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/30/2021] [Indexed: 12/19/2022] Open
Abstract
Traditionally, intubated general anesthesia with one-lung ventilation is standard in thoracoscopic surgery. However, in recent decades, non-intubated thoracoscopic surgery (NITS) has become an alternative method to minimize the adverse effects of intubated general anesthesia. Non-intubated procedures result in fewer adverse events than tracheal intubation and general anesthesia, such as intubation-related airway injury, ventilation-induced lung injury, prolonged hospital stay, and postoperative nausea and vomiting. Despite these benefits, surgeons must consider the possibility of converting to intubation during NITS as the conversion rate is between 2 and 11%, varying between regions and learning time. The conversion rate is also affected by race, body size, the learning curve, and the surgical team's preferred methods. There are surgical (e.g., significant respiratory movements, uncontrolled bleeding, hindered surgical fields, large tumor sizes, adhesions) and anesthetic (e.g., hypoxemia, hypercapnia, airway spasms) reasons for converting to intubation. When a conversion is deemed necessary by the surgical team, the members should be well-prepared and act rapidly. Anesthesiologists should also feel comfortable intubating patients in the lateral decubitus position with or without bronchoscopic guidance. Patient selection is the key factor for avoiding conversion into an intubated surgery. Patients with an American Society of Anesthesiologists grade 2 or less, a body mass index <25, and less surgical complexity may be good candidates for NITS. Careful monitoring, adequate anesthesia depth, an experienced surgical team, and sufficient preparation can also prevent conversion. Conversion from a non-intubated into intubated thoracic surgery is unwanted but not inevitable. Therefore, NITS can be successful when performed on select patients by a well-prepared and experienced surgical team and is worthy of recommendation owing to its non-invasiveness.
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Affiliation(s)
- Xu-Heng Chiang
- Department of Medical Education, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Mong-Wei Lin
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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13
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Li Y, Jiang Y, Su Z, Liang H, He J, Li S. Radical resection of solitary tracheal extramedullary plasmacytoma under non-intubated anesthesia: a case report. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1265. [PMID: 34532402 PMCID: PMC8421943 DOI: 10.21037/atm-21-1786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/20/2021] [Indexed: 11/06/2022]
Abstract
Extramedullary plasmacytoma (EMP) is an uncommon monoclonal plasma cell malignancy that arises outside of the bone marrow. Rarely, EMPs can occur in the trachea, resulting in severe respiratory distress. Due to a small number of cases, the optimal management of tracheal EMP remains a topic of debate. Here, we report a rare case of solitary tracheal EMP causing symptoms of cough, sputum, paroxysmal nocturnal dyspnea, and progressive exertional dyspnea in a 65-year-old male patient. Computerized tomography and fibro bronchoscopy indicated a pedicled nodular mass on the anterior tracheal wall obstructing over 95% of the lumen. The patient was soon successfully managed with partial tracheal resection and reconstruction surgery under non-intubated anesthesia and was diagnosed as EMP by histopathology of the resected mass. Additional laboratory tests excluded the diagnosis of multiple myeloma (MM). There are no signs of recurrence after 6 months of follow-up. Although traditional intubated anesthesia with single-lung mechanical ventilation has been widely applied to radical surgery for tracheal tumors, it is associated with a higher incidence of intubation-related complications and thus prolongs the surgical procedure and postoperative recovery. In this article, we reported the application of tracheal resection and reconstruction under non-intubated anesthesia for the treatment of tracheal EMP, which was proved to be feasible and safe. Non-intubated anesthesia for tracheal resection and reconstruction is likely to be an alternative minimally invasive option for patients with tracheal EMP involving central airways.
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Affiliation(s)
- Yinjun Li
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,State Key Laboratory of Respiratory Disease, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou, China.,Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Yu Jiang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,State Key Laboratory of Respiratory Disease, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou, China.,Guangzhou Institute of Respiratory Health, Guangzhou, China.,Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Zixuan Su
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,State Key Laboratory of Respiratory Disease, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou, China.,Guangzhou Institute of Respiratory Health, Guangzhou, China.,Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Hengrui Liang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,State Key Laboratory of Respiratory Disease, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou, China.,Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,State Key Laboratory of Respiratory Disease, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou, China.,Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Shuben Li
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,State Key Laboratory of Respiratory Disease, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou, China.,Guangzhou Institute of Respiratory Health, Guangzhou, China
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14
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Lan L, Jiang L, Duan C, Lu W, Zhang C, Cen Y, He J. A risk score for predicting postoperative complications in non-intubated thoracic surgery. J Thorac Dis 2021; 13:3960-3968. [PMID: 34422326 PMCID: PMC8339752 DOI: 10.21037/jtd-21-636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/20/2021] [Indexed: 11/06/2022]
Abstract
Background The risk factors for postoperative complications in non-intubated video-assisted thoracoscopic surgery (VATS) have not been observed before. Here to develop a simple risk score to predict the risk of postoperative complications for patients who scheduling non-intubated VATS, which is beneficial to guide the clinical interventions. Methods A total of 1,837 patients who underwent non-intubated VATS were included from January 2011 to December 2018. A development data set and a validation data set were allocated according to an approximate 3:2 ratio of total cases. The stepwise logistic regression was used to establish a risk score model, and the methods of bootstrap and split-sample were used for validation. Results Multivariable analysis revealed that the forced expiratory volume in the first second in percent of predicted, the anesthesia method, blood loss, surgical time, and preoperative neutrophil ratio were risk factors for postoperative complications. The risk score was established with these 5 factors, varied from 0 to 53, with the corresponding predicted probability of postoperative complications occurrence ranged from 1% to 92% and was calibrated (Hosmer-Lemeshow χ2 =6.261; P=0.618). Good discrimination was acquired in the development and validation data sets (C-statistic 0.705 and 0.700). A positive correlation was between the risk score and postoperative complications (P for trend <0.01). Three levels of low-risk (0-15 points], moderate-risk (15-30 points], and high-risk (>30 points] were established based on the score distribution of postoperative complications. Conclusions This simple risk score model based on risk factors of postoperative complications can validly identify the high-risk patients with postoperative complications in the non-intubated VATS, and allow for early interventions.
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Affiliation(s)
- Lan Lan
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Long Jiang
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Chongyang Duan
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Weixiang Lu
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China
| | - Canzhou Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yanyi Cen
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianxing He
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China
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15
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Costantino CL, Wright CD. Extended Pulmonary Resection by Sleeve Lobectomy and Carinal Pneumonectomy: Selection and Technique. Thorac Surg Clin 2021; 31:273-281. [PMID: 34304835 DOI: 10.1016/j.thorsurg.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Minimally invasive surgical approaches for extended pulmonary resections are becoming increasingly common as more surgeons gain experience in thoracoscopic and robotic technique. Outcome studies demonstrate improved decreased morbidity as compared with an open surgery.
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Affiliation(s)
- Christina L Costantino
- Department of Thoracic Surgery, Massachusetts General Hospital, GRB 4-425, Boston, MA 02114, USA
| | - Cameron D Wright
- Department of Thoracic Surgery, Massachusetts General Hospital, Founders House, FND-7, Boston, MA 02114, USA.
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16
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Wang C, Wu D, Pang P, Kong H, Zhao J, Chen X, Ye J, Pan Z, Liang W, Liu J, He J. Spontaneous Ventilation Video-Assisted Thoracoscopic Surgery for Geriatric Patients With Non-Small-Cell Lung Cancer. J Cardiothorac Vasc Anesth 2021; 36:510-517. [PMID: 34419362 DOI: 10.1053/j.jvca.2021.07.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 07/18/2021] [Accepted: 07/23/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The aim of the present study was to compare the short-term outcomes between spontaneous ventilation video-assisted thoracic surgery (SV-VATS) and mechanical ventilation video-assisted thoracic surgery (MV-VATS) in the elderly. All patients included in the present study underwent lobectomy, segmentectomy, or wedge resection and lymph node dissection. DESIGN A retrospective cohor. SETTING The first affiliated hospital of Guangzhou Medical University, Guangzhou, China. PARTICIPANTS The present study included 799 elderly patients diagnosed with non-small-cell lung cancer undergoing SV-VATS or MV-VATS. After propensity score matching, 80 patients in the SV-VATS group and 80 patients in the MV-VATS group were analyzed. INTERVENTIONS Patients in the SV-VATS group received spontaneous-ventilation anesthesia, which was administered as follows: intravenous anesthesia + laryngeal mask airway + thoracic paravertebral block + visceral pleural surface anesthesia + thoracic vagus nerve block. Patients in the MV-VATS group received general endotracheal anesthesia. SV-VATS or MV-VATS was performed according to the preference of the patients. MEASUREMENTS AND MAIN RESULTS There were no significant differences in anesthesia time (226.3 ± 79.8 v 238.5 ± 66.2 min; p = 0.44), surgery time (166.2 ± 102.6 v 170.1 ± 83.4 min; p = 0.66), and number of dissected lymph nodes (5.3 ± 7.5 v 4.4 ± 7.4; p = 0.23) between the two groups. There were significant differences in intraoperative bleeding (61.5 ± 165.1 v 82.2 ± 116.9 mL; p < 0.001). After surgery, the two groups were statistically comparable in terms of hospitalization (17.6 ± 7.6 v 17.2 ± 6.9 days; p = 0.95) and incidence of complications (7.5% v 13.8%; p = 0.20), while there were significant differences in chest tube duration (6.1 ± 3.3 v 4.5 ± 1.2 days; p < 0.001). CONCLUSIONS SV-VATS is feasible and as safe as MV-VATS, and it could be considered as an alternative treatment for the elderly.
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Affiliation(s)
- Chuqiao Wang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China; Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Donghong Wu
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China; Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Peilin Pang
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Han Kong
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Jieyi Zhao
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Xiaoying Chen
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Jingyi Ye
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Zhe Pan
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jun Liu
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.
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17
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Wen Y, Liang H, Qiu G, Liu Z, Liu J, Ying W, Liang W, He J. Non-intubated spontaneous ventilation in video-assisted thoracoscopic surgery: a meta-analysis. Eur J Cardiothorac Surg 2021; 57:428-437. [PMID: 31725158 DOI: 10.1093/ejcts/ezz279] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/05/2019] [Accepted: 09/05/2019] [Indexed: 12/19/2022] Open
Abstract
It remains unclear whether non-intubated video-assisted thoracoscopic surgery (VATS) is comparable or advantageous compared with conventional intubated VATS. Thus, we systematically assessed the feasibility and safety of non-intubated VATS compared with intubated VATS perioperatively for the treatment of different thoracic diseases. An extensive search of literature databases was conducted. Perioperative outcomes were compared between 2 types of operations. The time trend of the overall results was evaluated through a cumulative meta-analysis. Subgroup analyses of different thoracic diseases and study types were examined. Twenty-seven studies including 2537 patients were included in the analysis. A total of 1283 patients underwent non-intubated VATS; intubated VATS was performed on the other 1254 patients. Overall, the non-intubated VATS group had fewer postoperative overall complications [odds ratios (OR) 0.505; P < 0.001]; shorter postoperative fasting times [standardized mean difference (SMD) -2.653; P < 0.001]; shorter hospital stays (SMD -0.581; P < 0.001); shorter operative times (SMD -0.174; P = 0.041); shorter anaesthesia times (SMD -0.710; P < 0.001) and a lower mortality rate (OR 0.123; P = 0.020). Non-intubated VATS may be a safe and feasible alternative to intubated VATS and provide a more rapid postoperative rehabilitation time than conventional intubated VATS.
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Affiliation(s)
- Yaokai Wen
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.,Nanshan School, Guangzhou Medical University, Panyu District, Guangzhou, China
| | - Hengrui Liang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Guanping Qiu
- Nanshan School, Guangzhou Medical University, Panyu District, Guangzhou, China
| | - Zhichao Liu
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jun Liu
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Weiqiang Ying
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
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18
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Souza JM, Pereira IRPD, Borgmann AV, Chiaradia RE, Boscardim PCB. Uniportal surgical biopsy, without orotraqueal intubation, without thoracic drainage in intersticial pulmonary disease: initial results. Rev Col Bras Cir 2021; 48:e20202914. [PMID: 34133610 PMCID: PMC10683432 DOI: 10.1590/0100-6991e-20202914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/01/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE interstitial lung disease comprises a group of lung diseases with wide pathophysiological varieties. This paper aims to report the video thoracoscopic surgical biopsy in patients with interstitial lung disease through a single minimal chest incision, without orotracheal intubation, without chest drainage, and without the use of neuromuscular blockers. METHODS this study is a series of 14 cases evaluated retrospectively, descriptively, where patients underwent a pulmonary surgical biopsy from January 2019 to January 2020. The patients included in the study had diffuse interstitial lung disease without a defined etiological diagnosis. RESULTS none of the patients had transoperative complications, there was no need for chest drainage in the postoperative period, and the patients pain, assessed using the verbal scale, had a mode of 2 (minimum value of 1 and maximum of 4) in the post immediate surgery and 1 (minimum value of 1 and maximum of 3) at the time of hospital discharge. The length of hospital stay was up to 24 hours, with 12 patients being discharged on the same day of hospitalization. CONCLUSION therefore, it is concluded in this series of cases that the performance of uniportal video-assisted thoracoscopic surgery procedures to perform lung biopsies, without orotracheal intubation, without chest drainage, and without the use of neuromuscular blockers, bring benefits to the patient without compromising his safety. Further larger studies are necessary to confirm the safety and efficiency of this method.
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Affiliation(s)
- Juliano Mendes Souza
- - Faculdades Pequeno Príncipe, Curso de Medicina - Curitiba - PR - Brasil
- - Hospital Nossa Senhora das Graças, Departamento de Cirurgia Torácica - Curitiba - PR - Brasil
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19
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Wang ML, How CH, Hung MH, Huang HH, Hsu HH, Cheng YJ, Chen JS. Long-term outcomes after nonintubated versus intubated thoracoscopic lobectomy for clinical stage I non-small cell lung cancer: A propensity-matched analysis. J Formos Med Assoc 2021; 120:1949-1956. [PMID: 33994233 DOI: 10.1016/j.jfma.2021.04.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 03/08/2021] [Accepted: 04/26/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Nonintubated thoracoscopic lobectomy has been described as a feasible surgical treatment for early-stage lung cancer since 2011. Despite promising perioperative results, studies on tumor recurrence and long-term survival are very limited. This study was aimed to compare outcomes after thoracoscopic lobectomy with versus without intubation for stage I non-small cell lung cancer. METHODS A retrospective data set including 115 and 155 patients who underwent nonintubated and intubated thoracoscopic lobectomy, respectively, between January 2011 and December 2013 was used to identify matched nonintubated and intubated cohorts (n = 97 per group) using a propensity score matching algorithm that accounted for confounding effects of preoperative patient variables. Primary outcome variables included freedom from recurrence and overall survival. Factors affecting survival were assessed using Cox regression analysis and Kaplan-Meier survival estimates. RESULTS No perioperative mortality occurred in both groups. At an average follow-up of 74 months, comparing nonintubated thoracoscopic lobectomy with intubated procedure, no differences were observed in recurrence rates (14.4% vs. 25.8%, respectively; p = .057). Furthermore, no significant differences were noted in overall survival (97.9% vs. 93.8%, respectively; p = .144). Nonintubated thoracoscopic lobectomy was not found to be an independent predictor of recurrence (hazard ratio, .53; 95% confidence interval [CI], .28-1.02) or overall survival (hazard ratio, .33; 95% CI, .07-1.61). CONCLUSIONS In this propensity-matched comparison, nonintubated thoracoscopic lobectomy was not associated with an increased risk for recurrence and overall survival during the 5-year follow-up. However, more randomized trials should be conducted for further validation of these results.
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Affiliation(s)
- Man-Ling Wang
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Cheng-Hung How
- Division of Thoracic Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ming-Hui Hung
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hui-Hsun Huang
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsao-Hsun Hsu
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ya-Jung Cheng
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Anesthesiology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Jin-Shing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Surgical Oncology, National Taiwan University Cancer Center, Taiwan.
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20
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Xue W, Duan G, Zhang X, Zhang H, Zhao Q, Xin Z, He J. Comparison of non-intubated and intubated video-assisted thoracoscopic surgeries of major pulmonary resections for lung cancer-a meta-analysis. World J Surg Oncol 2021; 19:87. [PMID: 33757519 PMCID: PMC7988991 DOI: 10.1186/s12957-021-02181-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/02/2021] [Indexed: 01/11/2023] Open
Abstract
Objective The aim of this study was to compare the safety feasibility and safety feasibility of non-intubated (NIVATS) and intubated video-assisted thoracoscopic surgeries (IVATS) during major pulmonary resections. Methods A meta-analysis of eight studies was conducted to compare the real effects of two lobectomy or segmentectomy approaches during major pulmonary resections. Results Results showed that the patients using NIVATS had a greatly shorter hospital stay and chest-tube placement time (weighted mean difference (WMD): − 1.04 days; 95% CI − 1.50 to − 0.58; P < 0.01) WMD − 0.71 days; 95% confidence interval (CI), − 1.08 to − 0.34; P < 0.01, respectively) while compared to those with IVATS. There were no significant differences in postoperative complication rate, surgical duration, and the number of dissected lymph nodes. However, through the analysis of highly selected patients with lung cancer in early stage, the rate of postoperative complication in the NIVATS group was lower than that in the IVATS group [odds ratio (OR) 0.44; 95% CI 0.21–0.92; P = 0.03, I2 = 0%]. Conclusions Although the comparable postoperative complication rate was observed for major thoracic surgery in two surgical procedures, the NIVATS method could significantly shorten the hospitalized stay and chest-tube placement time compared with IVATS. Therefore, for highly selected patients, NIVATS is regarded as a safe and technically feasible procedure for major thoracic surgery. The assessment of the safety and feasibility for patients undergoing NIVATS needs further multi-center prospective clinical trials.
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Affiliation(s)
- Wenfei Xue
- Department of Thoracic Surgery, Hebei Province General Hospital, No 348, Heping Road West, Xinhua District, Shijiazhuang, 050000, China
| | - Guochen Duan
- Department of Thoracic Surgery, Hebei Province General Hospital, No 348, Heping Road West, Xinhua District, Shijiazhuang, 050000, China.
| | - Xiaopeng Zhang
- Department of Thoracic Surgery, Hebei Province General Hospital, No 348, Heping Road West, Xinhua District, Shijiazhuang, 050000, China
| | - Hua Zhang
- Department of Thoracic Surgery, Hebei Province General Hospital, No 348, Heping Road West, Xinhua District, Shijiazhuang, 050000, China
| | - Qingtao Zhao
- Department of Thoracic Surgery, Hebei Province General Hospital, No 348, Heping Road West, Xinhua District, Shijiazhuang, 050000, China
| | - Zhifei Xin
- Department of Thoracic Surgery, Hebei Province General Hospital, No 348, Heping Road West, Xinhua District, Shijiazhuang, 050000, China
| | - Jie He
- Department of Thoracic Surgery, Hebei Province General Hospital, No 348, Heping Road West, Xinhua District, Shijiazhuang, 050000, China
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21
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Metelmann I, Broschewitz J, Pietsch UC, Huschak G, Eichfeld U, Bercker S, Kraemer S. Procedural times in early non-intubated VATS program - a propensity score analysis. BMC Anesthesiol 2021; 21:44. [PMID: 33573604 PMCID: PMC7877094 DOI: 10.1186/s12871-021-01270-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 02/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-intubated video-assisted thoracic surgery (NiVATS) has been introduced to surgical medicine in order to reduce the invasiveness of anesthetic procedures and avoid adverse effects of intubation and one-lung ventilation (OLV). The aim of this study is to determine the time effectiveness of a NiVATS program compared to conventional OLV. METHODS This retrospective analysis included all patients in Leipzig University Hospital that needed minor VATS surgery between November 2016 and October 2019 constituting a NiVATS (n = 67) and an OLV (n = 36) group. Perioperative data was matched via propensity score analysis, identifying two comparable groups with 23 patients. Matched pairs were compared via t-Test. RESULTS Patients in NiVATS and OLV group show no significant differences other than the type of surgical procedure performed. Wedge resection was performed significantly more often under NiVATS conditions than with OLV (p = 0,043). Recovery time was significantly reduced by 7 min (p = 0,000) in the NiVATS group. There was no significant difference in the time for induction of anesthesia, duration of surgical procedure or overall procedural time. CONCLUSIONS Recovery time was significantly shorter in NiVATS, but this effect disappeared when extrapolated to total procedural time. Even during the implementation phase of NiVATS programs, no extension of procedural times occurs.
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Affiliation(s)
- Isabella Metelmann
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
| | - Johannes Broschewitz
- Department of General, Visceral, Thoracic and Vascular Surgery, Faculty of Health Sciences Brandenburg, Brandenburg Medical School, University Hospital Neuruppin, Fehrbelliner Strasse 38, 16816, Neuruppin, Germany
| | - Uta-Carolin Pietsch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Gerald Huschak
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
- OR Management, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Uwe Eichfeld
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Sven Bercker
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Sebastian Kraemer
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
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Spontaneous ventilation combined with double-lumen tube intubation in thoracic surgery. Gen Thorac Cardiovasc Surg 2021; 69:976-982. [PMID: 33433769 DOI: 10.1007/s11748-020-01572-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/12/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE We present the combination of spontaneous ventilation and double-lumen tube intubation in thoracic surgery. METHODS At the beginning of the procedures, the patients with a body mass index of ≤ 30 were relaxed for a short time, and a double-lumen tube was inserted. After the utility incision or thoracotomy, the vagus nerve was blocked (in right side in the upper mediastinum; in left side in the aorto-pulmonary window) with 3-5 ml of 0.5% bupivacaine. The patients had a bispectral index of 40-60. After the short relaxation period, the patients were ventilating spontaneously without any cough during the manipulation. RESULTS Between March 10 and September 18. 2020, 26 spontaneous ventilation combined with intubation surgeries were performed: 19 uniportal video-assisted thoracic surgery (15 lobectomies, 1 segmentectomy, and 3 wedge resections) and 7 open (5 lobectomies and 1 sleeve segmentectomy, 1 wedge resection). The mean mechanical and spontaneous one-lung ventilation time was 25.5 (15-115) and 73.3 (45-100) minutes, respectively. In 2 cases conversion to relaxation were necessary (2/26; 7.7%). The mean maximal carbon dioxide pressure was 52.3 (38-66) Hgmm and the mean lowest oxygen saturation was 93.8 (86-99) %. Breathing frequency ranged between 10-25/minute. The mean surgical times was 83.3 (55-130) minutes. CONCLUSIONS Spontaneous ventilation combined with intubation in video-assisted thoracic surgery or open resections is a safe method in selected patients. It can reduce the mechanical one-lung ventilation period with 76.6% and give safe airway for spontaneous ventilation thoracic procedures.
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Lai CJ, Chen JS, Ho SI, Lu ZY, Huang YJ, Cheng YJ. Detecting Oropharyngeal and Esophageal Emptying by Submental Ultrasonography and High-Resolution Impedance Manometry: Intubated vs. Non-Intubated Video-Assisted Thoracoscopic Surgery. Diagnostics (Basel) 2020; 10:diagnostics10121079. [PMID: 33322685 PMCID: PMC7763338 DOI: 10.3390/diagnostics10121079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 12/04/2022] Open
Abstract
Postoperative swallowing, affected by general anesthesia and intubation, plays an important part in airway and oral intake safety regarding effective oropharyngeal and esophageal emptying. However, objective evidence is limited. This study aimed to determine the time required from emergence to effective oropharyngeal and esophageal emptying in patients undergoing non-intubated (N) or tracheal-intubated (I) video-assisted thoracoscopic surgery (VATS). Hyoid bone displacement (HBD) by submental ultrasonography and high-resolution impedance manometry (HRIM) measurements were used to assess oropharyngeal and esophageal emptying. HRIM was performed every 10 min after emergence, up to 10 times. The primary outcome was to determine whether intubation affects the time required from effective oropharyngeal to esophageal emptying. The secondary outcome was to verify if HBD is comparable to preoperative data indicating effective oropharyngeal emptying. Thirty-two patients suitable for non-intubated VATS were recruited. Our results showed that comparable HBDs were achieved in all patients after emergence. Effective esophageal emptying was achieved at the first HRIM measurement in 11 N group patients and 2 I group patients (p = 0.002) and was achieved in all N (100%) and 13 I group patients (81%) within 100 min (p = 0.23). HBD and HRIM are warranted for detecting postoperative oropharyngeal and esophageal emptying.
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Affiliation(s)
- Chih-Jun Lai
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei 100025, Taiwan;
- Department of Anesthesiology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100225, Taiwan; (S.-IH.); (Z.-Y.L.); (Y.-J.H.)
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei 106037, Taiwan;
| | - Shih-I Ho
- Department of Anesthesiology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100225, Taiwan; (S.-IH.); (Z.-Y.L.); (Y.-J.H.)
| | - Zhi-Yin Lu
- Department of Anesthesiology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100225, Taiwan; (S.-IH.); (Z.-Y.L.); (Y.-J.H.)
| | - Yi-Ju Huang
- Department of Anesthesiology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100225, Taiwan; (S.-IH.); (Z.-Y.L.); (Y.-J.H.)
| | - Ya-Jung Cheng
- Department of Anesthesiology, College of Medicine, National Taiwan University, Taipei 100233, Taiwan
- Department of Anesthesiology, National Taiwan University Cancer Center, Taipei 106037, Taiwan
- Correspondence: ; Tel.: +886-2-2312-3456 (ext. 65517)
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Lin SF, Zheng YZ, Li XQ, Xu HP, Wang JJ, Wang W, Huang QY, Wu D, Zhong CX, Fu SS, Yuan LX, Wang SC, Luo RX, Zhai WY, Yu BT, Zhu KS. Impact of treatment modality on long-term survival of stage IA small-cell lung cancer patients: a cohort study of the U.S. SEER database. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1292. [PMID: 33209872 PMCID: PMC7661878 DOI: 10.21037/atm-20-5525] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background The optimal treatment modality for patients with stage IA (T1N0M0) small-cell lung cancer (SCLC) is still unclear. Methods Patients who received surgical resection or chemo-radiotherapy (CRT) between January 2004 and December 2014 were identified from The Surveillance, Epidemiology and End Results (SEER) database. Surgical resection included lobectomy, wedge resection, segmentectomy with lymphadenectomy [examined lymph node (ELN) ≥1]. Propensity score match analysis was utilized to balance the baseline characteristics. Results A total of 686 stage IA SCLC cases were included: 337 patients underwent surgery and 349 patients were treated by CRT alone. Surgery achieved a better outcome than CRT alone, with an adjusted hazard ratio (HR) of 0.495. Patients who underwent lobectomy demonstrated a longer overall survival (OS), compared to those who received sublobectomy (crude cohort, median OS, 69 vs. 38 months; match cohort, median OS, 67 vs. 38 months). Patients with ELN >7 presented with longer OS than those with ELN ≤7 (crude cohort, median OS, 91 vs. 49 months; matched cohort, median OS, 91 vs. 54 months). The additional efficacy of chemotherapy or radiotherapy in patients receiving lobectomy was observed. The best prognosis was achieved in the lobectomy plus CRT cohort, with a 5-year survival rate of 73.5%. Conclusions The prolonged survival associated with lobectomy and chemotherapy or radiotherapy presents a viable treatment option in the management of patients with stage IA SCLC.
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Affiliation(s)
- Shao-Feng Lin
- Department of Thoracic Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital& Fujian Provincial Key Laboratory of Tumor Biotherapy, Fuzhou, China
| | - Yu-Zhen Zheng
- Department of Thoracic Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao-Qiang Li
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Hai-Peng Xu
- Department of Thoracic Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Jun-Jie Wang
- Department of Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Wei Wang
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, NY, USA
| | - Qing-Yuan Huang
- Department of Thoracic Surgery, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Da Wu
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Chen-Xi Zhong
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shen-Shen Fu
- Department of Ultrasonography, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Lian-Xiong Yuan
- Office of Research Service, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangzhou, China
| | - Si-Chao Wang
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Rui-Xing Luo
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Wen-Yu Zhai
- Department of Thoracic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation, Guangzhou, China
| | - Ben-Tong Yu
- Department of Thoracic Surgery, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Kun-Shou Zhu
- Department of Thoracic Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital& Fujian Provincial Key Laboratory of Tumor Biotherapy, Fuzhou, China
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Furák J, Paróczai D, Burián K, Szabó Z, Zombori T. Oncological advantage of nonintubated thoracic surgery: Better compliance of adjuvant treatment after lung lobectomy. Thorac Cancer 2020; 11:3309-3316. [PMID: 32985138 PMCID: PMC7606006 DOI: 10.1111/1759-7714.13672] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Video-assisted thoracoscopic (VATS) surgery contributes to improved survival, adjuvant chemotherapy delivery and less postoperative complications. Nonintubated thoracic surgery (NITS) VATS procedures improves immunological responses in lung cancer patients; however, there is no data regarding adjuvant chemotherapy delivery effectiveness following NITS lobectomies. In this study, we aimed to compare protocol compliance and toxic complications during adjuvant chemotherapy after intubated and nonintubated VATS lobectomies in non-small cell lung cancer (NSCLC). METHODS We retrospectively reviewed the medical records of 66, stage IB-IIIB NSCLC patients who underwent intubated or nonintubated VATS lobectomy and received adjuvant chemotherapy. RESULTS A total of 38 patients (17 males, mean age 64 years) underwent conventional VATS and 28 (7 males; mean age 63 years) uniportal VATS NITS. Both groups had comparable demographic data, preoperative pulmonary function, and Eastern Cooperative Oncology Group (ECOG) status. Among the intubated and nonintubated patients, 82% and 75% were diagnosed with adenocarcinoma, respectively. The incidence of adenocarcinoma and squamous cell carcinoma cases were similar in both groups; however, the pathological staging showed significant differences, as 5 (18%) nonintubated patients had stage IB lung cancer, compared with the intubated group (P = 0.01). Further distribution of stages was similar between the groups. We observed significant differences in chest tube duration and operation time in the nonintubated group (P < 0.01). Among nonintubated patients, 92% completed the planned chemotherapy protocol, compared to 71% of the intubated group (P = 0.035). Grade 1/2 toxicity occurred significantly more often in the intubated group (16% vs. 0%, P = 0.03) and there was a lower incidence of grade 4 neutropenia in the nonintubated group (0% vs. 16%, P = 0.03). CONCLUSIONS Our results showed that the nonintubated procedure resulted in improved adjuvant chemotherapy compliance and lower toxicity rates after lobectomy. KEY POINTS SIGNIFICANT FINDINGS OF THE STUDY: Oncological advantage of the non-intubated thoracic surgery: better compliance with therapy protocol. What this study adds NITS lobectomies contribute to better administration of adjuvant chemotherapy with the planned cycle number and dosage.
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Affiliation(s)
- József Furák
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Dóra Paróczai
- Department of Pulmonology, University of Szeged, Deszk, Hungary.,Department of Medical Microbiology and Immunobiology, University of Szeged, Szeged, Hungary
| | - Katalin Burián
- Department of Medical Microbiology and Immunobiology, University of Szeged, Szeged, Hungary
| | - Zsolt Szabó
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Szeged, Hungary
| | - Tamás Zombori
- Department of Pathology, University of Szeged, Szeged, Hungary
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Liu HY, Chiang XH, Hung MH, Wang ML, Lin MW, Cheng YJ, Hsu HH, Chen JS. Nonintubated uniportal thoracoscopic segmentectomy for lung cancer. J Formos Med Assoc 2020; 119:1396-1404. [DOI: 10.1016/j.jfma.2020.03.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 02/25/2020] [Accepted: 03/23/2020] [Indexed: 11/16/2022] Open
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Nonintubated Versus Intubated Uniportal Thoracoscopic Segmentectomy for Lung Tumors. Ann Thorac Surg 2020; 111:1182-1189. [PMID: 32857994 DOI: 10.1016/j.athoracsur.2020.06.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/20/2020] [Accepted: 06/15/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Although the use of the uniportal thoracoscopic technique has spread exponentially recently, a comparison of nonintubated and intubated uniportal thoracoscopic segmentectomies for lung tumors has not been reported. We aimed to compare the feasibility, safety, and short-term postoperative outcomes between the 2 methods. METHODS From January 2014 to June 2019 we retrospectively reviewed 185 consecutive patients with lung tumors who underwent uniportal thoracoscopic segmentectomy at our institute. A body mass index of ≥25 kg/m2 was considered a contraindication for the nonintubated anesthetic approach. For the remaining cases the anesthetic approach was made at the discretion of each individual anesthesiologist. A propensity-matched analysis incorporating sex and body mass index was used to compare the clinical outcomes of the nonintubated and intubated groups. RESULTS Fifty patients (27.0%) underwent the procedure with the nonintubated anesthetic approach. The nonintubated group was more likely to be female (P < .001) and with a lower body mass index (P < .001). Other clinical features showed no significant difference. There was no significant difference between the 2 groups in the type of segmentectomy according to the difficulty classification system. After propensity matching 43 matched patients in each group were included. Anesthetic induction duration (12.0 vs 15.3 minutes, P = .014) was shorter in the nonintubated group. No other significant differences in perioperative, postoperative, and anesthetic results were noted between the 2 matched groups. CONCLUSIONS The nonintubated anesthetic approach can be a safe and feasible alternative to intubated uniportal thoracoscopic segmentectomy.
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Paradela de la Morena M, De La Torre Bravos M, Fernandez Prado R, Minasyan A, Garcia-Perez A, Fernandez-Vago L, Gonzalez-Rivas D. Standardized surgical technique for uniportal video-assisted thoracoscopic lobectomy. Eur J Cardiothorac Surg 2020; 58:i23-i33. [PMID: 32449910 DOI: 10.1093/ejcts/ezaa110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/09/2020] [Accepted: 02/04/2020] [Indexed: 12/13/2022] Open
Abstract
SUMMARY Uniportal video-assisted thoracoscopic surgery may be the approach for any thoracic procedure, from minor resections to complex reconstructive surgery. However, anatomical lobectomy represents its most common and clinically proven usage. A wide variety of information about uniportal video-assisted thoracoscopic lobectomies can be found in the literature and multimedia sources. This article focuses on updating the surgical technique and includes important aspects such as the geometric approach, anaesthesia considerations, operating room set-up, tips about the incision, instrumentation management and the operative technique to perform the 5 lobectomies. The following issues are explained for each lobectomy: anatomical considerations, surgical steps and technical advice. Medical illustrations and videos are included to clarify the text with the goal of describing a standard surgical practice.
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Affiliation(s)
| | | | - Ricardo Fernandez Prado
- Department of Thoracic Surgery and Lung Transplant, Coruña University Hospital, A Coruña, Spain
| | - Anna Minasyan
- Department of Thoracic Surgery and Lung Transplant, Coruña University Hospital, A Coruña, Spain
| | - Alejandro Garcia-Perez
- Department of Thoracic Surgery and Lung Transplant, Coruña University Hospital, A Coruña, Spain
| | - Luis Fernandez-Vago
- Department of Thoracic Surgery and Lung Transplant, Coruña University Hospital, A Coruña, Spain
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery and Lung Transplant, Coruña University Hospital, A Coruña, Spain.,Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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29
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Wu D, Liang H, Liang W, Liu H, Wang C, Wen Y, Jiang Y, Su Z, Peng H, Wang R, Chen Y, Jiang L, Zhao Y, Wang W, Liu J, He J. Spontaneous ventilation video-assisted thoracoscopic surgery for patients with non-small-cell lung cancer with excess body weight. Eur J Cardiothorac Surg 2020; 58:605-612. [PMID: 32447374 DOI: 10.1093/ejcts/ezaa125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/08/2020] [Accepted: 02/18/2020] [Indexed: 12/30/2022] Open
Abstract
Abstract
OBJECTIVES
The feasibility and safety of spontaneous ventilation (SV) video-assisted thoracoscopic surgery (VATS) for non-small-cell lung cancer (NSCLC) in patients with excess body weight [defined as body mass index (BMI) ≥ 25 kg/m2] remain unclear.
METHODS
Patients with NSCLC with excess body weight who underwent SV-VATS or mechanical ventilation (MV) VATS (MV-VATS) between April 2012 and July 2018 were analysed retrospectively. Propensity score matching was applied to balance the distribution of demographic characteristics. The short-term outcomes between the SV-VATS group and MV-VATS group were compared.
RESULTS
From April 2012 to July 2018, a total of 703 patients with excess body weight were included, 68 of whom underwent SV-VATS and 635 of whom underwent MV-VATS. After propensity score matching, the distribution of demographic characteristics was well balanced. BMIs (26.65 ± 1.74 vs 27.18 ± 2.36 kg/m2; P = 0.29) were similar between the groups. Patients who underwent SV-VATS had similar anaesthesia times (213 ± 57 vs 233 ± 67 min; P = 0.16) and similar operative times (122 ± 44 vs 142 ± 56 min; P = 0.086). The intraoperative bleeding volume, postoperative chest tube duration, volume of pleural drainage, number of dissected N1 and N2 station lymph nodes, length of hospitalization and incidence of complications were comparable between the 2 groups.
CONCLUSIONS
Primary lung cancer resection is feasible and not associated with safety issues under SV-VATS in selected patients with NSCLC with excess body weight.
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Affiliation(s)
- Donghong Wu
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Hengrui Liang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Hui Liu
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chuqiao Wang
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Yaokai Wen
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Yu Jiang
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Zixuan Su
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Haoxin Peng
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Runchen Wang
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Yingying Chen
- The First Clinical College, Guangzhou Medical University, Guangzhou, China
| | - Long Jiang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Yi Zhao
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Wei Wang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jun Liu
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
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30
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Wen Y, Jiang Y, Liang H, Jiang L, Guo Z, Musonza C, Thomas RL, Yang C, He J, Shen J, Chen L, Sun H, Wright GM, Zhang J, Yang Q, Zhong S, Liang W, Li S, Zhang J, He J. Tubeless video-assisted thoracic surgery for lung cancer: is it ready for prime time? Future Oncol 2020; 16:1229-1234. [PMID: 32379503 DOI: 10.2217/fon-2020-0278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Yaokai Wen
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, PR China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong 510120, PR China.,Nanshan School, Guangzhou Medical University, Guangzhou, Guangdong 511436, PR China
| | - Yu Jiang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, PR China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong 510120, PR China.,Nanshan School, Guangzhou Medical University, Guangzhou, Guangdong 511436, PR China
| | - Hengrui Liang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, PR China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong 510120, PR China
| | - Long Jiang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, PR China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong 510120, PR China
| | - Zhihua Guo
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, PR China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong 510120, PR China
| | - Clive Musonza
- Brown School at Washington University in St. Louis, St. Louis, Missouri 63130, USA
| | - R Lucas Thomas
- Washington University School of Medicine, St. Louis, Missouri 63110, USA.,University of Washington, Seattle, Washington 98195, USA
| | - Chenglin Yang
- Department of Thoracic Surgery, Shenzhen Center, Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong 518116, PR China
| | - Jiaxi He
- University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
| | - Jianfei Shen
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang 317000, PR China
| | - Lei Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong 510120, PR China.,Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, PR China
| | - Haibo Sun
- Department of Thoracic Surgery, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan 450008, PR China
| | - Gavin M Wright
- Department of Surgery, University of Melbourne; Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia.,Department of Cardiothoracic Surgery, St. Vincent's Hospital, Melbourne, Victoria 3065, Australia.,Victorian Comprehensive Cancer Center, Melbourne, Victoria 3000, Australia
| | - Jian Zhang
- Thoracic Surgery Department, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, PR China
| | - Qintai Yang
- Department of Otorhinolaryngology-Head & Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, PR China
| | - Shengyi Zhong
- Department of Cardiothoracic Surgery, Xianning Central Hospital, Xianning, Wuhan 437100, PR China
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, PR China
| | - Shuben Li
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, PR China
| | - Jianrong Zhang
- Brown School at Washington University in St. Louis, St. Louis, Missouri 63130, USA.,Victorian Comprehensive Cancer Center, Melbourne, Victoria 3000, Australia.,Department of General Practice, Melbourne Medical School; Cancer in Primary Care Research Group, Centre for Cancer Research, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, PR China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong 510120, PR China
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31
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Furák J, Szabó Z, Tánczos T, Paszt A, Rieth A, Németh T, Pécsy B, Ottlakán A, Rárosi F, Lázár G, Molnár Z. Conversion method to manage surgical difficulties in non-intubated uniportal video-assisted thoracic surgery for major lung resection: simple thoracotomy without intubation. J Thorac Dis 2020; 12:2061-2069. [PMID: 32642108 PMCID: PMC7330381 DOI: 10.21037/jtd-19-3830] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background The major limitations of widespread use of non-intubated thoracic surgery (NITS) is the fear of managing complications. Here we present our practice of converting from uniportal video-assisted thoracic surgery (VATS) NITS to open NITS in cases of surgical complications. Methods The study period was from January 26, 2017, to November 30, 2018. Total intravenous anesthesia was provided with propofol guided by bispectral index, and the airway was maintained with a laryngeal mask with spontaneous breathing. Local anesthesia with 2% lidocaine at the skin incision, and intercostal and vagus nerve blockades were induced using 0.5% bupivacaine. For conversion with surgical indications, a thoracotomy was performed at the incision without additional local or general anesthetics. Results In 160 complete NITS procedures, there were 145 VATS NITS and 15 open NITS (9 conversions to open NITS and 6 intended NITS thoracotomies). In the 15 open NITS cases (2 pneumonectomies, 1 bilobectomy, 1 sleeve lobectomy, 7 lobectomies, 3 sublobar resections, 1 exploration), the mean operative time was 146.7 (105–225) and 110 (75–190) minutes in the converted and intended open NITS groups, respectively. There were no significant differences between systolic blood pressure (P=0.316; 95% CI, −10.469 to 3.742), sat O2% (P=0.27; 95% CI, −1.902 to 0.593), or propofol concentration in the effect site (P=0.053; 95% CI, −0.307 to 0.002) but significant differences in pulse (P=0.007; 95% CI, −10.001 to −2.72), diastolic blood pressure (P=0.013; 95% CI, −9.489 to −1.420) and in end-tidal CO2 (P=0.016; 95% CI, −7.484 to −0.952) before versus after thoracotomy, but there was no clinical relevance of the differences. Conclusions For conversion with surgical indications during the VATS-NITS procedure, NITS thoracotomy can be performed safely at the site of the utility incision without the need for additional drugs, and the major lung resections can be performed through this approach.
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Affiliation(s)
- József Furák
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Zsolt Szabó
- Department of Anesthesiology, University of Szeged, Szeged, Hungary
| | - Tamás Tánczos
- Department of Anesthesiology, University of Szeged, Szeged, Hungary
| | - Attila Paszt
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Anna Rieth
- Department of Pediatrics, University of Szeged, Szeged, Hungary
| | - Tibor Németh
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Balázs Pécsy
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Aurél Ottlakán
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Ferenc Rárosi
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - György Lázár
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Zsolt Molnár
- Institute for Translational Medicine, University of Pécs, Pécs, Hungary
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32
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Boisen ML, Schisler T, Kolarczyk L, Melnyk V, Rolleri N, Bottiger B, Klinger R, Teeter E, Rao VK, Gelzinis TA. The Year in Thoracic Anesthesia: Selected Highlights from 2019. J Cardiothorac Vasc Anesth 2020; 34:1733-1744. [PMID: 32430201 DOI: 10.1053/j.jvca.2020.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/09/2020] [Indexed: 12/25/2022]
Abstract
THIS special article is the 4th in an annual series for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the editor-in-chief, Dr. Kaplan; the associate editor-in-chief, Dr. Augoustides; and the editorial board for the opportunity to expand this series, the research highlights of the year that specifically pertain to the specialty of thoracic anesthesia. The major themes selected for 2019 are outlined in this introduction, and each highlight is reviewed in detail in the main body of the article. The literature highlights in this specialty for 2019 include updates in the preoperative assessment and optimization of patients undergoing lung resection and esophagectomy, updates in one lung ventilation (OLV) and protective ventilation during OLV, a review of recent meta-analyses comparing truncal blocks with paravertebral catheters and the introduction of a new truncal block, meta-analyses comparing nonintubated video-assisted thoracoscopic surgery (VATS) with those performed using endotracheal intubation, a review of the Society of Thoracic Surgeons (STS) recent composite score rating for pulmonary resection of lung cancer, and an update of the Enhanced Recovery After Surgery (ERAS) guidelines for both lung and esophageal surgery.
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Affiliation(s)
- Michael L Boisen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Travis Schisler
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver General Hospital, Vancouver, Canada
| | - Lavinia Kolarczyk
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Vladyslav Melnyk
- Department of Anesthesiology and Pain Medicine, University of Toronto - Toronto General Hospital, Toronto, Canada
| | - Noah Rolleri
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | | | - Emily Teeter
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Vidya K Rao
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
| | - Theresa A Gelzinis
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA.
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33
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Cui F, Xu K, Liang H, Liang W, Li J, Wang W, Liu H, Liu J, He J. Spontaneous ventilation versus mechanical ventilation during video-assisted thoracoscopic surgery for spontaneous pneumothorax: a study protocol for multicenter randomized controlled trial. J Thorac Dis 2020; 12:1570-1581. [PMID: 32395294 PMCID: PMC7212161 DOI: 10.21037/jtd.2020.02.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background With the evolution and adoption of video-assisted thoracoscopic surgery (VATS), options for anesthesia control have also seen major developments. Intubated anesthesia with single lung mechanical ventilation VATS (MV-VATS) is considered the standard of care in VATS. However, this type of ventilation strategy has been associated with several adverse effects, which can trigger complications and increase the overall surgical risk. In order to avoid intubated anesthesia related adverse effects, non-intubated spontaneous ventilation VATS (SV-VATS) strategies have been proposed in recent years and widely applied. Methods We established a two-arm parallel multicenter randomized controlled trial for comparative analysis of the outcomes of patients undergoing either SV-VATS or MV-VATS for spontaneous pneumothorax. Outcomes of interest include safety during operation, total analgesic dose, recovery time, postoperative complication rates, postoperative pain score, length of hospitalization, inflammation index, medical cost, etc. The recruitment target is 316 patients. Patients will be eligible if their chest CT is diagnosed with “localized lung bullae” and need VATS resection. Patients will be randomized into the SV-VATS (test group) or MV-VATS (control group) after signing informed consent and surgical anesthesia evaluation. Discussion This protocol has been approved by the Research Ethics Committee of the First Affiliated Hospital of Guangzhou Medical university. Results will be presented at national and international meetings and conferences and published in peer-reviewed journals. We will also disseminate the main results to all participants in a letter. Non-intubated SV-VATS offered a more individual choice of anesthetics and surgical method for spontaneous pneumothorax patients. Trial registration NCT03016858; pre-results.
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Affiliation(s)
- Fei Cui
- Department of Thoracic Surgery, First Affiliated Hospital of Guangzhou Medical University, National Respiratory Disease Clinical Research Center, Guangzhou 510120, China
| | - Ke Xu
- Department of Thoracic Surgery, First Affiliated Hospital of Guangzhou Medical University, National Respiratory Disease Clinical Research Center, Guangzhou 510120, China
| | - Hengrui Liang
- Department of Thoracic Surgery, First Affiliated Hospital of Guangzhou Medical University, National Respiratory Disease Clinical Research Center, Guangzhou 510120, China
| | - Wenhua Liang
- Department of Thoracic Surgery, First Affiliated Hospital of Guangzhou Medical University, National Respiratory Disease Clinical Research Center, Guangzhou 510120, China
| | - Jingpei Li
- Department of Thoracic Surgery, First Affiliated Hospital of Guangzhou Medical University, National Respiratory Disease Clinical Research Center, Guangzhou 510120, China
| | - Wei Wang
- Department of Thoracic Surgery, First Affiliated Hospital of Guangzhou Medical University, National Respiratory Disease Clinical Research Center, Guangzhou 510120, China
| | - Hui Liu
- Department of Anesthesia, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Jun Liu
- Department of Thoracic Surgery, First Affiliated Hospital of Guangzhou Medical University, National Respiratory Disease Clinical Research Center, Guangzhou 510120, China
| | - Jianxing He
- Department of Thoracic Surgery, First Affiliated Hospital of Guangzhou Medical University, National Respiratory Disease Clinical Research Center, Guangzhou 510120, China
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Navarro-Martínez J, Galiana-Ivars M, Rivera-Cogollos MJ, Gálvez C, Nadal SB, Lamaignère MO, Mazo ED. Management of Intraoperative Crisis During Nonintubated Thoracic Surgery. Thorac Surg Clin 2020; 30:101-110. [PMID: 31761278 DOI: 10.1016/j.thorsurg.2019.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nonintubated video-assisted thoracoscopic surgery programs have gradually spread all over the world. The benefits are based on less invasiveness and earlier recovery. However, complications may appear. For the correct prevention and management of all these potentially critical situations, the principles of crisis resource management (CRM) must be followed. They should also include clinical simulation as a tool to generate different scenarios to improve teamwork. The purpose of this special issue is to appraise and summarize the design, implementation, and efficacy of simulation-based CRM training programs for a specific surgery, including the management of specific surgical and medical critical scenarios.
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Affiliation(s)
- Jose Navarro-Martínez
- Anesthesiology Department and Surgical Critical Care Unit, Hospital General Universitario de Alicante, C/Pintor Baeza no. 12, Alicante 03010, Spain.
| | - Maria Galiana-Ivars
- Anesthesiology Department and Surgical Critical Care Unit, Hospital General Universitario de Alicante, C/Pintor Baeza no. 12, Alicante 03010, Spain
| | - María Jesús Rivera-Cogollos
- Anesthesiology Department and Surgical Critical Care Unit, Hospital General Universitario de Alicante, C/Pintor Baeza no. 12, Alicante 03010, Spain
| | - Carlos Gálvez
- Thoracic Surgery Department, Hospital General Universitario de Alicante, C/Pintor Baeza no. 12, Alicante 03010, Spain
| | - Sergio Bolufer Nadal
- Thoracic Surgery Department, Hospital General Universitario de Alicante, C/Pintor Baeza no. 12, Alicante 03010, Spain
| | | | - Elena Díez Mazo
- Hospital General Universitario de Alicante, C/Pintor Baeza no. 12, Alicante 03010, Spain
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Gálvez C, Bolufer S, Gálvez E, Navarro-Martínez J, Galiana-Ivars M, Sesma J, Rivera-Cogollos MJ. Anatomic Segmentectomy in Nonintubated Video-Assisted Thoracoscopic Surgery. Thorac Surg Clin 2020; 30:61-72. [PMID: 31761285 DOI: 10.1016/j.thorsurg.2019.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Thoracic surgery has evolved into minimally invasive surgery, in terms of not only surgical approach but also less aggressive anesthesia protocols and lung-sparing resections. Nonintubated anatomic segmentectomies are challenging procedures but can be safely performed if some essentials are considered. Strict selection criteria, previous experience in minor procedures, multidisciplinary cooperation, and the 4 cornerstones (deep sedation, regional analgesia, oxygenation support and vagal blockade) should be followed. Better outcomes in postoperative recovery, including resumption of oral intake, chest tube duration, and hospital stay, and low complication and conversion rates, are encouraging but should be checked in larger multicenter prospective randomized trials.
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Affiliation(s)
- Carlos Gálvez
- Thoracic Surgery Department, Hospital General Universitario Alicante, C/Pintor Baeza, 12, Alicante 03010, Spain.
| | - Sergio Bolufer
- Thoracic Surgery Department, Hospital General Universitario Alicante, C/Pintor Baeza, 12, Alicante 03010, Spain
| | - Elisa Gálvez
- Medical Oncology, Hospital General Universitario Elda, Ctra. Sax- La Torreta, S/N, Elda, Alicante 03600, Spain
| | - Jose Navarro-Martínez
- Anesthesiology and Surgical Critical Care Department, Hospital General Universitario Alicante, C/Pintor Baeza, 12, Alicante 03010, Spain
| | - Maria Galiana-Ivars
- Anesthesiology and Surgical Critical Care Department, Hospital General Universitario Alicante, C/Pintor Baeza, 12, Alicante 03010, Spain
| | - Julio Sesma
- Thoracic Surgery Department, Hospital General Universitario Alicante, C/Pintor Baeza, 12, Alicante 03010, Spain
| | - María Jesús Rivera-Cogollos
- Anesthesiology and Surgical Critical Care Department, Hospital General Universitario Alicante, C/Pintor Baeza, 12, Alicante 03010, Spain
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36
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Hung WT, Cheng YJ, Chen JS. Video-Assisted Thoracoscopic Surgery Lobectomy for Lung Cancer in Nonintubated Anesthesia. Thorac Surg Clin 2020; 30:73-82. [DOI: 10.1016/j.thorsurg.2019.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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38
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Abstract
Nonintubated anesthesia is feasible and might be associated with shorter surgery time and shorter hospitalization for tracheal/carinal resection and reconstruction. Only case reports and a few small retrospective series study were conducted to evaluate nonintubated anesthesia for tracheal/carinal resection and reconstruction; no randomized control trials exist. Further exploration should focus on selection of optimal candidates and prospective validation.
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39
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Qaqish TR, Cox S, Carr R, Katlic M. Treatment of Pleural Effusions with Nonintubated Video-Assisted Thoracoscopic Surgery. Thorac Surg Clin 2019; 30:25-32. [PMID: 31761281 DOI: 10.1016/j.thorsurg.2019.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Video-assisted thoracic surgery has considerably improved the care of the thoracic surgical patient. Patients are able to leave the hospital sooner and experience less pain with equal oncologic outcomes when compared with open surgery. Nonintubated thoracic surgery has more recently been applied in the management of both benign and malignant pleural effusions. This article provides the general thoracic surgeon a detailed description on how to manage pleural effusions using video-assisted thoracoscopic surgery in a nonintubated patient. Surgical techniques and pearls are also presented.
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Affiliation(s)
- Thamer Robert Qaqish
- Department of Surgery, Sinai Hospital of Baltimore, 2435 West Belvedere Avenue, Suite 42, Baltimore, MD 21215, USA
| | - Solange Cox
- Department of Surgery, Sinai Hospital of Baltimore, 2435 West Belvedere Avenue, Suite 42, Baltimore, MD 21215, USA
| | - Rebecca Carr
- Department of Surgery, Sinai Hospital of Baltimore, 2435 West Belvedere Avenue, Suite 42, Baltimore, MD 21215, USA
| | - Mark Katlic
- Department of Surgery, Sinai Hospital of Baltimore, 2435 West Belvedere Avenue, Suite 42, Baltimore, MD 21215, USA.
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40
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Yu MG, Jing R, Mo YJ, Lin F, Du XK, Ge WY, Dai HJ, Hu ZK, Zhang SS, Pan LH. Non-intubated anesthesia in patients undergoing video-assisted thoracoscopic surgery: A systematic review and meta-analysis. PLoS One 2019; 14:e0224737. [PMID: 31714904 PMCID: PMC6850529 DOI: 10.1371/journal.pone.0224737] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/21/2019] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Non-intubated anesthesia (NIA) has been proposed for video-assisted thoracoscopic surgery (VATS), although how the benefit-to-risk of NIA compares to that of intubated general anesthesia (IGA) for certain types of patients remains unclear. Therefore, the aim of the present meta-analysis was to understand whether NIA or IGA may be more beneficial for patients undergoing VATS. METHODS A systematic search of Cochrane Library, Pubmed and Embase databases from 1968 to April 2019 was performed using predefined criteria. Studies comparing the effects of NIA or IGA for adult VATS patients were considered. The primary outcome measure was hospital stay. Pooled data were meta-analyzed using a random-effects model to determine the standard mean difference (SMD) with 95% confidence intervals (CI). RESULTS AND DISCUSSION Twenty-eight studies with 2929 patients were included. The median age of participants was 56.8 years (range 21.9-76.4) and 1802 (61.5%) were male. Compared to IGA, NIA was associated with shorter hospital stay (SMD -0.57 days, 95%CI -0.78 to -0.36), lower estimated cost for hospitalization (SMD -2.83 US, 95% CI -4.33 to -1.34), shorter chest tube duration (SMD -0.32 days, 95% CI -0.47 to -0.17), and shorter postoperative fasting time (SMD, -2.76 days; 95% CI -2.98 to -2.54). NIA patients showed higher levels of total lymphocytes and natural killer cells and higher T helper/T suppressor cell ratio, but lower levels of interleukin (IL)-6, IL-8 and C-reactive protein (CRP). Moreover, NIA patients showed lower levels of fibrinogen, cortisol, procalcitonin and epinephrine. CONCLUSIONS NIA enhances the recovery from VATS through attenuation of stress and inflammatory responses and stimulation of cellular immune function.
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Affiliation(s)
- Mei-gang Yu
- Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
- The Laboratory of Perioperative Medicine Research Center, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Department of Anesthesiology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Ren Jing
- Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
- The Laboratory of Perioperative Medicine Research Center, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yi-jie Mo
- Department of Anesthesiology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Fei Lin
- Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
- The Laboratory of Perioperative Medicine Research Center, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xue-ke Du
- Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
- The Laboratory of Perioperative Medicine Research Center, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Wan-yun Ge
- Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
- The Laboratory of Perioperative Medicine Research Center, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Hui-jun Dai
- Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
- The Laboratory of Perioperative Medicine Research Center, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Zhao-kun Hu
- Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
- The Laboratory of Perioperative Medicine Research Center, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Sui-sui Zhang
- Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
- The Laboratory of Perioperative Medicine Research Center, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Ling-hui Pan
- Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
- The Laboratory of Perioperative Medicine Research Center, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
- * E-mail:
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Hung WT, Cheng YJ, Chen JS. Nonintubated thoracoscopic surgery for early-stage non-small cell lung cancer. Gen Thorac Cardiovasc Surg 2019; 68:733-739. [PMID: 31605286 DOI: 10.1007/s11748-019-01220-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Recent advances in the management of early-stage non-small cell lung cancer have focused on less invasive anesthetic and surgical techniques. Video-assisted thoracoscopic surgery without tracheal intubation is an evolving technique to provide a safe alternative with less short-term complication and faster postoperative recovery. The purpose of this review was to explore the latest developments and future prospects of nonintubated thoracoscopic surgery for early lung cancer. METHODS We examined various techniques and surgical procedures as well as the outcomes and benefits. RESULTS The results indicated a new era of video-assisted thoracoscopic surgery in which there is reduced procedure-related injury and enhanced postoperative recovery for lung cancer. CONCLUSIONS Nonintubated thoracoscopic surgery is a safe and feasible minimally invasive alternative surgery for early non-small cell lung cancer. Faster recovery and less short-term complication are potential benefits of this approach.
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Affiliation(s)
- Wan-Ting Hung
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei, 10002, Taiwan
| | - Ya-Jung Cheng
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.,National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jin-Shing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei, 10002, Taiwan. .,National Taiwan University College of Medicine, Taipei, Taiwan.
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42
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He J, Liu J, Zhu C, Dai T, Cai K, Zhang Z, Cheng C, Qiao K, Liu X, Wang G, Xu S, Yang R, Fan J, Li H, Jin J, Dong Q, Liang L, Ding J, He K, Liu Y, Ye J, Feng S, Jiang Y, Huang H, Zhang H, Liu Z, Feng X, Xia Z, Ma M, Duan Z, Huang T, Li Y, Shen Q, Tan W, Ma H, Sun Y, Chen C, Cui F, Wang W, Li J, Hao Z, Liu H, Liang W, Zou X, Liang H, Yang H, Li Y, Jiang S, Ng CSH, González-Rivas D, Pompeo E, Flores RM, Shargall Y, Ismail M, Bedetti B, Elkhouly AG, Ang K. Expert consensus on spontaneous ventilation video-assisted thoracoscopic surgery in primary spontaneous pneumothorax (Guangzhou). ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:518. [PMID: 31807500 DOI: 10.21037/atm.2019.10.08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Jianxing He
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Jun Liu
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Chengchu Zhu
- Department of Thoracic Surgery, Taizhou Hospital, Taizhou 318000, China
| | - Tianyang Dai
- Department of Thoracic Surgery, Southwest Medical University Affiliated Hospital, Luzhou 646000, China
| | - Kaican Cai
- Department of Thoracic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou 510120, China
| | - Zhifeng Zhang
- Department of Thoracic Surgery, Jieyang People's Hospital, Jieyang 522000, China
| | - Chao Cheng
- Department of Thoracic Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510120, China
| | - Kun Qiao
- Department of Thoracic Surgery, Third People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Xiang Liu
- Department of Thoracic Surgery, Second Affiliated Hospital of the University of South China, Hengyang 420100, China
| | - Guangsuo Wang
- Department of Thoracic Surgery, People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Shun Xu
- Department of Thoracic Surgery, First Affiliated Hospital of China Medical University, Shenyang 110000, China
| | - Rusong Yang
- Department of Thoracic Surgery, Nanjing Chest Hospital, Nanjing 210000, China
| | - Junqiang Fan
- Department of Thoracic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200000, China
| | - Jiang Jin
- Department of Thoracic Surgery, Taizhou Hospital, Taizhou 318000, China
| | - Qinglong Dong
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Lixia Liang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Jinfeng Ding
- Department of Anesthesia, Taizhou Hospital, Taizhou 318000, China
| | - Kaiming He
- Department of Thoracic Surgery, Southwest Medical University Affiliated Hospital, Luzhou 646000, China
| | - Yulin Liu
- Department of Anesthesia, Southwest Medical University Affiliated Hospital, Luzhou 646000, China
| | - Jing Ye
- Department of Anesthesia, Nanfang Hospital of Southern Medical University, Guangzhou 510120, China
| | - Siyang Feng
- Department of Thoracic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou 510120, China
| | - Yu Jiang
- Department of Anesthesia, Nanfang Hospital of Southern Medical University, Guangzhou 510120, China
| | - Haoda Huang
- Department of Thoracic Surgery, Jieyang People's Hospital, Jieyang 522000, China
| | - Huankai Zhang
- Department of Anesthesia, Jieyang People's Hospital, Jieyang 522000, China
| | - Zhenguo Liu
- Department of Thoracic Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510120, China
| | - Xia Feng
- Department of Anesthesia, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510120, China
| | - Zhaohua Xia
- Department of Thoracic Surgery, Third People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Mingfei Ma
- Department of Anesthesia, Third People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Zhongxin Duan
- Department of Anesthesia, Second Affiliated Hospital of the University of South China, Guangzhou 510120, China
| | - Tonghai Huang
- Department of Thoracic Surgery, People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Yali Li
- Department of Anesthesia, People's Hospital of Shenzhen, Shenzhen 518000, China
| | - Qiming Shen
- Department of Thoracic Surgery, First Affiliated Hospital of China Medical University, Shenyang 110000, China
| | - Wenfei Tan
- Department of Thoracic Surgery, First Affiliated Hospital of China Medical University, Shenyang 110000, China
| | - Hong Ma
- Department of Anesthesia, First Affiliated Hospital of China Medical University, Shenyang 110000, China
| | - Yang Sun
- Department of Anesthesia, Nanjing Chest Hospital, Nanjing 210000, China
| | - Congcong Chen
- Department of Anesthesia, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Fei Cui
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Wei Wang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Jingpei Li
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Zhexue Hao
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Hui Liu
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Wenhua Liang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Xusen Zou
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Hengrui Liang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Hanyu Yang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Yingfen Li
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Shunjun Jiang
- National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Calvin S H Ng
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | | | - Eugenio Pompeo
- Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy
| | - Raja M Flores
- Department of Thoracic Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yaron Shargall
- Division of Thoracic Surgery, McMaster University, St. Joseph's Healthcare, Hamilton, Canada
| | - Mahmoud Ismail
- Department of Thoracic Surgery, Klinikum Ernst von Bergmann, Academic Hospital of the Charité - Universitätsmedizin Humboldt University Berlin, Potsdam Germany
| | | | - Ahmed G Elkhouly
- Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Keng Ang
- Department of Thoracic Surgery, Nottingham City Hospital and Glenfield Hospital, Leicester, UK
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43
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Zhang K, Chen HG, Wu WB, Li XJ, Wu YH, Xu JN, Jia YB, Zhang J. Non-intubated video-assisted thoracoscopic surgery vs. intubated video-assisted thoracoscopic surgery for thoracic disease: a systematic review and meta-analysis of 1,684 cases. J Thorac Dis 2019; 11:3556-3568. [PMID: 31559062 DOI: 10.21037/jtd.2019.07.48] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Non-intubated video-assisted thoracoscopic surgery (NIVATS) has been increasingly used in lobectomy, bullectomy, wedge resection, lung volume reduction, sympathectomy and talc pleurodesis, which may reduce postoperative complications. However, the benefits of non-intubated and intubated methods of VATS remain controversial. Methods We comprehensively searched PubMed, Web of Science, Embase and the Cochrane Library, and performed a systematic review to assess the two techniques. Random and fixed-effects meta-analytical models were used based on the low between-study heterogeneity. Study quality, publication bias, and heterogeneity were assessed. Results Compared to intubated methods, NIVATS had a lower postoperative complications rate [odds ratio (OR): 0.63; 95% confidence interval (CI), 0.46-0.86; P<0.01], shorter global in-operating time [weighted mean difference (WMD): -35.96 min; 95% CI, -48.00 to -23.91; P<0.01], shorter hospital stay (WMD: -1.35 days; 95% CI, -1.72 to -0.98; P<0.01), shorter anesthesia time (WMD: -7.29 min; 95% CI, -13.30 to -1.29; P<0.01), shorter chest-tube placement time (WMD: -1.04 days; 95% CI, -1.75 to -0.33; P<0.01), less chest pain (WMD: -1.31; 95% CI, -2.45 to -0.17; P<0.05) and lower perioperative mortality rate (OR: 0.13; 95% CI, 0.02-0.99; P=0.05). Conclusions NIVATS is a safe, efficient and feasible technique for thoracic surgery and may be a better alternative procedure owing to its advantage in reducing postoperative complications rate, hospital stay, and chest pain.
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Affiliation(s)
- Kai Zhang
- Department of Thoracic Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Hui-Guo Chen
- Department of Thoracic Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Wei-Bin Wu
- Department of Thoracic Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Xiao-Jun Li
- Department of Thoracic Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Yong-Hui Wu
- Department of Thoracic Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Jian-Nan Xu
- Department of Thoracic Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Yu-Bin Jia
- Department of Thoracic Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Jian Zhang
- Department of Thoracic Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
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44
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Liang H, Liu J, Wu S, Zhang Y, Liu H, Yang H, Zhao Y, Hao Z, Liang W, He J. Nonintubated Spontaneous Ventilation Offers Better Short-term Outcome for Mediastinal Tumor Surgery. Ann Thorac Surg 2019; 108:1045-1051. [PMID: 31181206 DOI: 10.1016/j.athoracsur.2019.04.052] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 04/03/2019] [Accepted: 04/17/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nonintubated spontaneous ventilation video-assisted thoracoscopic surgery (NI-VATS) has been investigated to reduce the adverse effects of tracheal intubation, mechanical ventilation, and general anesthesia in several thoracic diseases. We comparatively assess the comparison between NI-VATS vs intubated anesthesia VATS (I-VATS) on early outcomes of mediastinal lesion resection. METHODS Patients who underwent VATS resection for a mediastinal tumor between December 2015 and September 2018 were retrospectively included for analysis. Patients were divided into two groups according to anesthesia ventilation type: NI-VATS and I-VATS. Propensity score matching was applied to eliminate population bias. Intraoperative and postoperative variables were compared. RESULTS A total of 198 patients was included; 75 patients underwent NI-VATS and 123 patients underwent I-VATS. After propensity score matching, both anesthesia time (173.81 vs 227.37 minutes, P < .001) and operation time (82.82 vs 133.49 minutes, P < .001) were shorter in the NI-VATS group. Bleeding (51.80 mL vs 56.73 mL, P = .90) and postoperative morbidity (10.9% vs 15.6%, P = .57) were similar between groups. Chest tube duration (1.11 vs 1.54 days, P = .04) was shorter in the NI-VATS group. Hospital duration after surgery (3.15 vs 5.35 days, P < .001) was shorter in the NI-VATS group. D-dimer after surgery was significantly higher in both groups, but NI-VATS decreased the change (577 vs 1624 μg/L, P < .001). Furthermore, a decrease in the use of postoperative opioids analgesics was seen in the NI-VATS group (31% vs 51%, P = .023). CONCLUSIONS Mediastinal tumor resection is safe and feasible under NI-VATS. Better short-term outcomes suggest NI-VATS facilitates a more rapid recovery. Further multicenter prospective randomized investigation is warranted.
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Affiliation(s)
- Hengrui Liang
- Department of Thoracic Surgery and Oncology, First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jun Liu
- Department of Thoracic Surgery and Oncology, First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Shilong Wu
- Department of Thoracic Surgery and Oncology, First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Yaoliang Zhang
- Department of Anesthesia, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hui Liu
- Department of Anesthesia, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hanyu Yang
- Department of Anesthesia, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yi Zhao
- Department of Thoracic Surgery and Oncology, First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Zhexue Hao
- Department of Thoracic Surgery and Oncology, First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.
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45
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Hung WT, Hung MH, Wang ML, Cheng YJ, Hsu HH, Chen JS. Nonintubated Thoracoscopic Surgery for Lung Tumor: Seven Years’ Experience With 1,025 Patients. Ann Thorac Surg 2019; 107:1607-1612. [DOI: 10.1016/j.athoracsur.2019.01.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/05/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
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46
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Pompeo E, Rogliani P, Atinkaya C, Guerrera F, Ruffini E, Iñiguez-Garcia MA, Peer M, Voltolini L, Caviezel C, Weder W, Opitz I, Cavalli F, Sorge R. Nonintubated surgical biopsy of undetermined interstitial lung disease: a multicentre outcome analysis. Interact Cardiovasc Thorac Surg 2019; 28:744-750. [DOI: 10.1093/icvts/ivy320] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Eugenio Pompeo
- Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy
| | - Paola Rogliani
- Respiratory Unit, Department of Experimental Medicine, Policlinico Tor Vergata University, Rome, Italy
| | - Cansel Atinkaya
- Department of Thoracic Surgery, Health Science University, Sureyyapasa Training and Research Hospital Chest and Thoracic Disease, Maltepe Istanbul, Turkey
| | | | - Enrico Ruffini
- Department of Thoracic Surgery, University of Turin, Turin, Italy
| | | | - Michael Peer
- Department of Thoracic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Luca Voltolini
- Department of Thoracic Surgery, University Hospital Careggi, Florence, Italy
| | - Claudio Caviezel
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Francesco Cavalli
- Respiratory Unit, Department of Experimental Medicine, Policlinico Tor Vergata University, Rome, Italy
| | - Roberto Sorge
- Section of Biostatistics, Tor Vergata University, Rome, Italy
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47
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Solli P, Brandolini J, Bertolaccini L. Tubeless thoracic surgery: ready for prime time? J Thorac Dis 2019; 11:652-656. [PMID: 31019751 DOI: 10.21037/jtd.2019.03.01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Piergiorgio Solli
- Department of Thoracic Surgery, Maggiore Teaching Hospital, Bologna, Italy
| | - Jury Brandolini
- Department of Thoracic Surgery, Maggiore Teaching Hospital, Bologna, Italy
| | - Luca Bertolaccini
- Department of Thoracic Surgery, Maggiore Teaching Hospital, Bologna, Italy
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48
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Girrbach FF, Pietsch UC, Wrigge H. Optimizing intraoperative ventilation during one-lung ventilation-is individualization the road to success? J Thorac Dis 2019; 11:S343-S346. [PMID: 30997216 DOI: 10.21037/jtd.2018.12.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Felix F Girrbach
- Department of Anesthesiology and Intensive Care, University Hospital of Leipzig, Leipzig, Germany
| | - Uta C Pietsch
- Department of Anesthesiology and Intensive Care, University Hospital of Leipzig, Leipzig, Germany
| | - Hermann Wrigge
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Pain Therapy, Bergmannstrost Hospital Halle, Halle, Germany
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49
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Elia S, Loprete S, De Stefano A, Hardavella G. Does aggressive management of solitary pulmonary nodules pay off? Breathe (Sheff) 2019; 15:15-23. [PMID: 30838056 PMCID: PMC6395991 DOI: 10.1183/20734735.0275-2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Indeterminate solitary pulmonary nodules (SPNs), measuring up to 3 cm in diameter, are incidental radiological findings. The ever-growing use of modern imaging has increased their detection. The majority of those nodules are benign; however, the possibility of diagnosing early-stage lung cancer still stands. Guidelines for the management of SPNs have never been validated in prospective comparative studies. Positron emission tomography (PET) is a useful tool to provide functional information on SPNs. However, overall sensitivity and specificity of PET in detecting malignant SPNs of at least 10 mm in diameter are about 90% and false-negative results are reported. The development of video-assisted thoracic surgery has provided minimally invasive diagnosis and treatment of SPNs. In our series, 105 patients underwent surgery based on combined increased 18F-labelled 2-fluoro-2-deoxy-d-glucose (FDG) uptake on PET computed tomography and radiological features (morphology and density) without prior histological confirmation. We detected 26 false negatives (24.8%) and only nine false positives (8.57%). Therefore, our minimally invasive surgical approach prevented 25% of patients with lung cancer from a delayed treatment versus only 9% undergoing “overtreatment”. In our monocentric cohort, patients with SPNs with large diameter, irregular outline, no calcifications, central location, increased FDG uptake and/or subsolid aspect benefited from a primary surgical resection. There is much debate on the best management of solitary pulmonary nodules. Even if they are mostly benign, they may represent an early-stage lung cancer. Minimally invasive surgical removal is probably the best approach to this insidious disease.http://ow.ly/wMKz30nemjR
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Affiliation(s)
- Stefano Elia
- Dept of Surgical Sciences, Thoracic Surgery Unit, Tor Vergata University, Rome, Italy
| | - Serafina Loprete
- Dept of Biomedicine and prevention, Tor Vergata University, Rome, Italy
| | | | - Georgia Hardavella
- Dept of Respiratory Medicine and Allergy, Medical School, King's College London, London, UK.,10th Dept of Respiratory Medicine, Athens' Chest Diseases Hospital "Sotiria", Athens, Greece
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50
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Ali JM, Volpi S, Kaul P, Aresu G. Does the ‘non-intubated’ anaesthetic technique offer any advantage for patients undergoing pulmonary lobectomy? Interact Cardiovasc Thorac Surg 2018; 28:555-558. [DOI: 10.1093/icvts/ivy312] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 10/02/2018] [Accepted: 10/14/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jason M Ali
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
| | - Sara Volpi
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
| | - Pradeep Kaul
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
| | - Giuseppe Aresu
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
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