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Anile M, Vannucci J, Ferrante F, Bruno K, De Paolo D, Bassi M, Pugliese F, Venuta F. Non-Intubated Thoracic Surgery: Standpoints and Perspectives. Front Surg 2022; 9:937633. [PMID: 36034396 PMCID: PMC9407015 DOI: 10.3389/fsurg.2022.937633] [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: 05/06/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Non-intubated video-assisted thoracic surgery (NI-VATS) combines the advantages of a non-intubated surgery with the benefits of a minimally invasive approach. First, NI-VATS is performed in the case of fragile patients when general anesthesia and/or orotracheal intubation can be foreseen as inconvenient. However, NI-VATS indications have been increasingly extended to different patient conditions, considering the increasingly assessed safety and feasibility of the procedure. Currently, the NI-VATS approach is used worldwide for different thoracic surgery procedures, including the management of malignant pleural effusion, surgical treatment of empyema, anatomical and non-anatomical lung resection, and other indications. In fact, this approach has shown to be less impactful than VATS under general anesthesia, allowing for shortened hospitalization and faster recovery after surgery. Besides, NI-VATS is associated with fewer pulmonary complications, less respiratory distress, and a mild systemic inflammatory reaction. For these reasons, this approach should be considered not only in patients with poor cardiac or respiratory function (general functional reserve), but also in other eligible conditions. We explored the anesthetic and surgical aspects of such an approach, including the management of analgesia, cough reflex, depth of sedation, and intraoperative technical issues to put this approach in perspective.
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Affiliation(s)
- Marco Anile
- Department of Thoracic Surgery and Lung Transplantation, University of Rome Sapienza, Policlinico Umberto I, Rome, Italy
| | - Jacopo Vannucci
- Department of Thoracic Surgery and Lung Transplantation, University of Rome Sapienza, Policlinico Umberto I, Rome, Italy
| | - Francesco Ferrante
- Department of Thoracic Surgery and Lung Transplantation, University of Rome Sapienza, Policlinico Umberto I, Rome, Italy
| | - Katia Bruno
- Department of Anesthesiology and Critical Care, University of Rome Sapienza, Policlinico Umberto I, Rome, Italy
| | - Dalila De Paolo
- Department of Anesthesiology and Critical Care, University of Rome Sapienza, Policlinico Umberto I, Rome, Italy
| | - Massimiliano Bassi
- Department of Thoracic Surgery and Lung Transplantation, University of Rome Sapienza, Policlinico Umberto I, Rome, Italy
| | - Francesco Pugliese
- Department of Anesthesiology and Critical Care, University of Rome Sapienza, Policlinico Umberto I, Rome, Italy
| | - Federico Venuta
- Department of Thoracic Surgery and Lung Transplantation, University of Rome Sapienza, Policlinico Umberto I, Rome, Italy
- Correspondence: Federico Venuta
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Ferrari PA, Tamburrini A. Robotic-assisted non-intubated tracheal resection: the most excellent care or an unnecessary surgical challenge? ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1632. [PMID: 34926676 PMCID: PMC8640900 DOI: 10.21037/atm-21-4686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/30/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Paolo A Ferrari
- Division of Thoracic Surgery, "A. Businco" Oncology Hospital, A.R.N.A.S. "G. Brotzu", Cagliari, Italy
| | - Alessandro Tamburrini
- Division of Thoracic Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Kösek V, Al Masri E, Redwan B. Recent advances in non-intubated robotic-assisted thoracic surgery (NiRATS) for tracheal/airway resection and reconstruction. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1510. [PMID: 34805372 PMCID: PMC8573427 DOI: 10.21037/atm-21-4986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 09/29/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Volkan Kösek
- Department of Thoracic Surgery, Klinik am Park, Klinikum Westfalen, Lünen, Germany
| | - Eyad Al Masri
- Department of Thoracic Surgery, Klinik am Park, Klinikum Westfalen, Lünen, Germany
| | - Bassam Redwan
- Department of Thoracic Surgery, Klinik am Park, Klinikum Westfalen, Lünen, Germany
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Gokce M, Altinsoy B, Piskin O, Bahadir B. Uniportal VATS pleural biopsy in the diagnosis of exudative pleural effusion: awake or intubated? J Cardiothorac Surg 2021; 16:95. [PMID: 33879212 PMCID: PMC8056594 DOI: 10.1186/s13019-021-01461-7] [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: 07/22/2020] [Accepted: 04/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background The aim of this study is to compare the diagnostic efficacy and safety of video-assisted thoracoscopic surgery (VATS) with awake VATS (AVATS) pleural biopsy in undiagnosed exudative pleural effusions. Methods The diagnostic efficacy of pleural biopsy by uniportal VATS under general anesthesia or AVATS under local anesthesia and sedation performed by the same surgeon in patients with undiagnosed exudative pleural effusion between 2007 and 2020 were retrospectively evaluated. Test sensitivity, specificity, positive predictive value and negative predictive value were compared as well as age, gender, comorbidities, procedure safety, additional pleural-based interventions, duration time of operation and length of hospital stay. Results Of 154 patients with undiagnosed exudative pleural effusion, 113 (73.37%) underwent pleural biopsy and drainage with VATS, while 41 (26.62%) underwent AVATS pleural biopsy. Sensitivity, specificity, positive predictive value and negative predictive value were 92, 100, 100, and 85.71% for VATS, and 83.3, 100, 100, and 78.9% for AVATS, respectively. There was no significant difference in diagnostic test performance between the groups, (p = 0.219). There was no difference in the rate of complications [15 VATS (13.3) versus 4 AVATS (9.8%), p = 0.557]. Considering additional pleural-based interventions, while pleural decortication was performed in 13 (11.5%) cases in the VATS group, no pleural decortication was performed in AVATS group, (p = 0.021). AVATS group was associated with shorter duration time of operation than VATS (22.17 + 6.57 min. Versus 51.93 + 8.85 min., p < 0.001). Length of hospital stay was relatively shorter in AVATS but this was not statistically significant different (p = 0.063). Conclusions Our study revealed that uniportal AVATS pleural biopsy has a similar diagnostic efficacy and safety profile with VATS in the diagnosis and treatment of patients with undiagnosed pleural effusion who have a high risk of general anesthesia due to advanced age and comorbidities. Accordingly, uniportal AVATS pleural biopsy may be considered in the diagnosis and treatment of all exudative undiagnosed pleural effusions.
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Affiliation(s)
- Mertol Gokce
- Department of Thoracic Surgery, Bulent Ecevit University Faculty of Medicine, Zonguldak, Turkey.
| | - Bulent Altinsoy
- Department of Pulmonary Medicine, Bulent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Ozcan Piskin
- Department of Anesthesiology and Reanimation, Bulent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Burak Bahadir
- Department of Pathology, Bulent Ecevit University Faculty of Medicine, Zonguldak, Turkey
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Zhang XX, Song CT, Gao Z, Zhou B, Wang HB, Gong Q, Li B, Guo Q, Li HF. A comparison of non-intubated video-assisted thoracic surgery with spontaneous ventilation and intubated video-assisted thoracic surgery: a meta-analysis based on 14 randomized controlled trials. J Thorac Dis 2021; 13:1624-1640. [PMID: 33841954 PMCID: PMC8024812 DOI: 10.21037/jtd-20-3039] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Video-assisted thoracic surgery (VATS) generally involves endotracheal intubation under general anesthesia. However, inevitably, this may cause intubation-related complications and prolong the postoperative recovery process. Gradually, non-intubated video-assisted thoracic surgery (NIVATS) is increasingly being utilized. However, its safety and efficacy remain controversial. Methods Randomized controlled trials (RCTs) published up to August 2020 were selected from the Cochrane Library, Web of Science, PubMed, Embase, and ClinicalTrials.gov databases and included in this study according to the inclusion criteria. Two reviewers screened these RCTs and independently extracted the relevant data. After assessing the risk of bias in these RCTs, a meta-analysis was performed using Review Manager 5.3. Pooled data were meta-analyzed using a random-effects model. Results Meta-analysis data demonstrated that the mean difference (MD) in the length of hospital stay between non-intubated patients and intubated patients was −1.41 days, with a 95% confidence interval (CI) of −2.47 to −0.34 (P=0.01). The visual analogue scale (VAS) score between the two groups showed a MD of −0.34 (95% CI: −0.58 to −0.10; P=0.006). Patients who underwent NIVATS presented with lower rates of overall complications [odds ratio (OR) 0.41; 95% CI: 0.25 to 0.67; P=0.0004], air leak (OR 0.45; 95% CI: 0.24 to 0.87; P=0.02), pharyngeal discomfort (OR 0.08; 95% CI: 0.04 to 0.17; P<0.00001), hoarseness (OR 0.06; 95% CI: 0.02 to 0.21; P<0.00001), and gastrointestinal reactions (OR 0.23; 95% CI: 0.10 to 0.53; P=0.0005) compared to intubated patients. The anesthesia satisfaction scores in the NIVATS group were significantly higher than those of the VATS group (MD 0.50; 95% CI: 0.12 to 0.88; P=0.009). However, there were no statistically significant differences in the length of operation time (MD 0.90 hours; 95% CI: −0.23 to 2.03; P=0.12) and surgical field satisfaction (1 point) (OR 0.73; 95% CI: 0.34 to 1.59; P=0.43) between the two groups. Conclusions NIVATS is a safe and feasible form of intervention that can reduce the postoperative pain and complications of various systems and shorten hospital stay duration without prolonging the operation time.
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Affiliation(s)
- Xi-Xuan Zhang
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China
| | - Chun-Tao Song
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China
| | - Zhen Gao
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China
| | - Bin Zhou
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China
| | - Hai-Bo Wang
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China
| | - Qiang Gong
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China
| | - Ben Li
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China
| | - Qiang Guo
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China
| | - He-Fei Li
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China
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Comparison of awake and intubated video-assisted thoracoscopic surgery in the diagnosis of pleural diseases: A prospective multicenter randomized trial. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 27:550-556. [PMID: 32082924 DOI: 10.5606/tgkdc.dergisi.2019.18214] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/05/2019] [Indexed: 11/21/2022]
Abstract
Background This study aims to compare the safety and diagnostic accuracy of awake and intubated video-assisted thoracoscopic surgery in the diagnosis of pleural diseases. Methods This prospective randomized study was conducted between October 2016 and April 2018 and included 293 patients (201 males, 92 females; mean age 53.59 years; range, 18 to 90 years) from five medical centers experienced in video-assisted thoracoscopic surgery. The patients were randomized into two groups as awake video-assisted thoracoscopic surgery with sedoanalgesia (non-intubated) and video-assisted thoracoscopic surgery with general anesthesia (intubated). Patients with undiagnosed pleural effusions and pleural pathologies such as nodules and masses were included. Conditions such as pain, agitation, and hypoxia were indications for intubation. The groups were compared in terms of demographic data, postoperative pain, operative time, complications, diagnostic accuracy of the procedures, and cost. All patients completed a follow-up period of at least 12 months for samples that were non-specific, suspicious for malignancy or inadequate. Results Awake video-assisted thoracoscopic surgery was performed in 145 and intubated video-assisted thoracoscopic surgery was performed in 148 patients. Pleural disease was unilateral in 83% (243/293) and bilateral in 17% (50/293) of the patients. There was no difference between the groups in terms of presence of comorbidity (p=0.149). One patient in the awake video-assisted thoracoscopic surgery group (0.6%) was converted to general anesthesia due to refractory pain and agitation. As postoperative complications, fluid drainage and pneumonia were observed in one patient in the awake video-assisted thoracoscopic surgery group (0.6%) and fluid drainage was detected in one patient in the video-assisted thoracoscopic surgery group (0.6%). There were no differences in pain intensity measured with visual analog scale at postoperative 4, 8, 12, or 24 hours (p>0.05). Distribution and rates of postoperative pathological diagnoses were also similar (p=0.171). Both operative cost and total hospital cost were lower in the awake video-assisted thoracoscopic surgery group (p<0.001, p=0.001). Conclusion Our study showed that awake video-assisted thoracoscopic surgery is safe, has similar reliability and diagnostic accuracy compared to video-assisted thoracoscopic surgery performed under general anesthesia, and is less costly. Awake video-assisted thoracoscopic surgery can be the first method of choice in all patients, not only in those with comorbidities.
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Jung J, Kim DH, Son J, Lee SK, Son BS. Comparative study between local anesthesia and general anesthesia in the treatment of primary spontaneous pneumothorax. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:553. [PMID: 31807534 DOI: 10.21037/atm.2019.09.89] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background There is increasing interest in non-intubated video-assisted thoracoscopic surgery (VATS). At present, this method is used in various types of thoracic surgery. Especially, simple wedge resection via VATS is thought to be an optimal indication of non-intubated VATS. This study was performed to evaluate the usefulness of VATS bullectomy under local anesthesia by comparison with bullectomy under general anesthesia. Methods A total of 183 cases of wedge resection under general anesthesia and 52 cases of wedge resection under local anesthesia were examined. Medical records were retrospectively reviewed to assess the feasibility, usability, and cost effectiveness of wedge resection under local anesthesia. The preoperative clinical parameters, including age, sex, and the number of pneumothorax episodes and previous operations, were used to match cases and controls. Results There were no significant differences between the local and general anesthesia groups in operative time (57.5±23.1 and 56.6±25.6 min, respectively; P=0.857), type of operation [single-incision thoracoscopic surgery (SITS), n=48 and n=47, respectively; multi-port-VATS (M-VATS), n=4 and n=5, respectively; P=0.730], or chest tube indwelling time (3.6±1.5 and 4.4±2.5 days, respectively; P=0.064). The mean times from arrival at the operating room (OR) to skin incision (16.4±12.3 and 46.4±17.2 min, respectively; P<0.001), and from the end of surgery to arrival at the general ward (36.0±25.6 and 58.1±20.9 min, respectively; P<0.001) were significantly shorter in the local anesthesia group than the general anesthesia group. The total cost was significantly lower in the local anesthesia group than in the general anesthesia group (4,890.6±717.1 and 5,739.1±1,154.6, respectively; P<0.001). Conclusions Local anesthesia shortened the overall hospital stay by reducing the interval between admission and surgery, allowing immediate ambulation after surgery. In addition, this method reduced costs by avoiding the need for anesthesia.
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Affiliation(s)
- Joonho Jung
- Department of Thoracic and Cardiovascular Surgery, Ajou University Hospital, Suwon, Korea
| | - Do Hyung Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Medical Research Institute of Pusan National University, Busan, Korea
| | - Joohyung Son
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Medical Research Institute of Pusan National University, Busan, Korea
| | - Sung Kwang Lee
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Medical Research Institute of Pusan National University, Busan, Korea
| | - Bong Soo Son
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Medical Research Institute of Pusan National University, Busan, Korea
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Szabó Z, Tanczos T, Lebak G, Molnár Z, Furák J. Non-intubated anaesthetic technique in open bilobectomy in a patient with severely impaired lung function. J Thorac Dis 2018; 10:E275-E280. [PMID: 29850168 DOI: 10.21037/jtd.2018.04.80] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
General anaesthesia has been the most commonly used method for almost all types of thoracic surgery. Recently, there has been a growing interest in non-intubated anaesthetic techniques. The rationale being, to prevent complications related to general anaesthesia and positive pressure ventilation such as barotrauma or ventilation-perfusion mismatch. We present a case with severely impaired forced expiration volume (26%), carbon monoxide diffusing capacity (26%) and VO2max (13.9 mL/kg/min). According to current guidelines, this patient was suitable to undergo one-lung ventilation only with high risk of morbidity and mortality. Therefore, we chose the non-intubated technique for thoracotomy. Oxygenation was satisfactory throughout, the patient remained hemodynamically stable and the operation was uneventful. Oxygen supplementation was stopped from day 2 and he was discharged on day 7. To our knowledge, this is the first case report where a planned non-intubated method was applied for thoracotomy, and our results suggest that it might be a feasible and safe approach for open thoracotomy in difficult cases where severely impaired lung function indicates that one lung ventilation may carry significant risks.
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Affiliation(s)
- Zsolt Szabó
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Tanczos
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Gábor Lebak
- Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Zsolt Molnár
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - József Furák
- Department of Surgery, Faculty of Medicine, University of Szeged, Szeged, Hungary
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Hwang J, Shin JS, Son JH, Min TJ. Non-intubated thoracoscopic bullectomy under sedation is safe and comfortable in the perioperative period. J Thorac Dis 2018; 10:1703-1710. [PMID: 29707324 DOI: 10.21037/jtd.2018.02.10] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Non-intubated thoracoscopic surgery can be performed under sedation using adjuvant regional anesthesia, however, the benefits of non-intubated thoracoscopic surgery under sedation have not yet been completely verified. In this study, we compare the perioperative safety and pain complaints of sedation without intubation in thoracoscopic bullectomy with that of conventional general anesthesia with double-lumen intubation and mechanical ventilation. Methods Forty-one patients with primary spontaneous pneumothorax who were scheduled for thoracoscopic bullectomy were enrolled in this study. Twenty-one patients were under sedation anesthesia (SA group) and 20 patients were under general anesthesia (GA group). In SA group, sedation was done with dexmedetomidine (a loading dose of 1 µg/kg for 10 min and then maintained in dosages of 0.3-1 µg/kg/h) and ketamine (2-4 mg/kg/h intraoperatively). Meanwhile, in GA group, induction with propofol and rocuronium, intubation with double lumen endotracheal tube and maintenance with 1.0-2.5% sevoflurane was done. In both groups, thoracoscopic bullectomy was performed in the same manner and all operations were conducted by single surgeon. Time for anesthesia [including emergence time and post-anesthesia care unit (PACU) recovery time] and operation, postoperative pain, sore throat, hoarseness, adverse events (nausea, vomiting, hypotension and bradycardia), dose of rescue analgesic drug used for 24 hours post-operatively and perioperative arterial blood gas analysis were recorded. Results The times for anesthesia, operation and emergence were significantly shorter in SA than GA. Incidence of sore throat were significantly lower in SA. The difference of other adverse events in the two groups was not significant. Conclusions Our study demonstrated that compared to double-lumen intubation with general anesthesia, non-intubation with sedation for bullectomy for primary spontaneous pneumothorax was safe and efficient to reduce perioperative time.
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Affiliation(s)
- Jinwook Hwang
- Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jae Seung Shin
- Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Joo Hyung Son
- Korea University Post-Graduate School of Medicine, Seoul, Korea
| | - Too Jae Min
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do, Korea
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Bedetti B, Patrini D, Bertolaccini L, Crisci R, Solli P, Schmidt J, Scarci M. Uniportal non-intubated thoracic surgery. J Vis Surg 2018; 4:18. [PMID: 29445604 DOI: 10.21037/jovs.2017.12.09] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 12/07/2017] [Indexed: 11/06/2022]
Abstract
Uniportal video-assisted thoracoscopic surgery (VATS) is the most advanced evolution of the minimally invasive technique, which allows often the possibility to include patients in enhanced recovery programs in order to optimize the therapeutic pathway, shorten the length of stay and reduce hospital costs. Non-intubated VATS procedures allow the performance of surgeries with minimal sedation without general anesthesia, maintaining throughout the operation spontaneous breathing. The principle is to create an iatrogenic spontaneous pneumothorax, which can provide a good lung isolation without the need of a double lumen tube. A survey between the members of the European Society of Thoracic Surgery (ESTS) showed that non-intubated VATS procedures are already performed by a large number of ESTS members for minor procedures. With the publication of new data and the spreading of uniportal VATS in many centers worldwide in the last decades, the application of the non-intubated technique in major procedure like anatomic resections is expected to grow. This technique can potentially be beneficial for high-risk patients but also could be used for the routine procedures as well, but more data are needed to establish the real benefit for these groups of patients.
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Affiliation(s)
| | - Davide Patrini
- Department of Thoracic Surgery, University College of London Hospitals, London, UK
| | - Luca Bertolaccini
- Department of Thoracic Surgery, Bellaria and Maggiore Hospitals, Bologna, Italy
| | - Roberto Crisci
- Department of Thoracic Surgery, Mazzini Hospital, University of L'Aquila, Teramo, Italy
| | - Piergiorgio Solli
- Department of Thoracic Surgery, Bellaria and Maggiore Hospitals, Bologna, Italy
| | - Joachim Schmidt
- Department of Thoracic Surgery, Malteser Hospital, Bonn, Germany
| | - Marco Scarci
- Department of Thoracic Surgery, University College of London Hospitals, London, UK
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Affiliation(s)
- Andrea Zuin
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Marco Mammana
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
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Wang ML, Galvez C, Chen JS, Navarro-Martinez J, Bolufer S, Hung MH, Hsu HH, Cheng YJ. Non-intubated single-incision video-assisted thoracic surgery: a two-center cohort of 188 patients. J Thorac Dis 2017; 9:2587-2598. [PMID: 28932566 DOI: 10.21037/jtd.2017.08.96] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Non-intubated single-incision procedures are slowly expanding because of high experience and skill required, and stricter selection criteria. The aim of this study is to present the first retrospective two-center series in Taiwan and Spain. METHODS We performed a retrospective analysis of 188 patients undergoing non-intubated single-incision video-assisted thoracic surgery (NI-SI-VATS) procedures between July 2013 to November 2015 in two centers in Taiwan (170 patients) and Spain (18 patients) with two different anesthetic methods. Demographic data, clinicopathological features, preoperative tests, and final outcomes were analyzed to compare the outcomes with the two different techniques. RESULTS Of the 188 patients, 147 (78%) were women, with a mean body mass index (BMI) of 22.7. Of the 196 specimens, 145 (74%) were malignancies with a mean size of 9.7 mm. Wedge resection was performed in 172 patients (91.4%), anatomical segmentectomy with lymphadenectomy in 8 (4.7%), and lobectomy with lymphadenectomy in 5 (2.6%). Three patients (1.6%) required conversion to orotracheal intubation, while 5 patients (2.7%) required additional ports. Complications appeared in 16 patients (8.5%) with air leak as the most frequent in 7 cases (3.7%). Median chest drainage was 1 day, and median postoperative stay was 3 days. There was neither perioperative death nor postoperative readmission. CONCLUSIONS Non-intubated single-incision procedures can be feasible and safe in expert hands and experienced teams, even for anatomical resections. Strict selection criteria, skill and experience are mandatory. Comparative cohorts and randomized trials are needed.
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Affiliation(s)
- Man-Ling Wang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Carlos Galvez
- Department of Thoracic Surgery, University General Hospital of Alicante, Alicante, Spain
| | - Jin-Shing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University, Taipei, Taiwan
| | - Jose Navarro-Martinez
- Department of Anesthesiology and Surgical Critical Care Department, University General Hospital of Alicante, Alicante, Spain
| | - Sergio Bolufer
- Department of Thoracic Surgery, University General Hospital of Alicante, Alicante, Spain
| | - Ming-Hui Hung
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsao-Hsung Hsu
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University, Taipei, Taiwan
| | - Ya-Jung Cheng
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
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Gonfiotti A, Bongiolatti S, Viggiano D, Borgianni S, Borrelli R, Tancredi G, Jaus MO, Politi L, Comin CE, Voltolini L. Does videomediastinoscopy with frozen sections improve mediastinal staging during video-assisted thoracic surgery pulmonary resections? J Thorac Dis 2016; 8:3496-3504. [PMID: 28149542 DOI: 10.21037/jtd.2016.12.45] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND To assess if video-mediastinoscopy (VM) with frozen sections (FS) combined with a video-assisted thoracic surgery major pulmonary resection (VMPRS) is able to improve VATS mediastinal intraoperative staging. METHODS From June 2012 to March 2015 a total of 146 patients underwent VMPRS lymphadenectomy. NCCN guidelines were followed for pre-operative staging, including VM with FS in 27 patients (19%). Procedural time, dissected nodal stations, complications related to VM and VATS lymphadenectomy and definitive histology, were evaluated. RESULTS Operative time for VATS resection with VM (group 1) and VATS pulmonary resection alone (group 2) was 198±64 vs. 167±43 min (P=0.003). Mean/median numbers of dissected nodal stations were 4.93±1.1/5 (range, 4-8) in group 1 and 3.25±0.5/5 (range, 3-8) in group 2 (P<0.001). Group 1 vs. group 2 right-sided lymphadenectomy (n=86) was performed at station 2R/4R in 18 (90%) and 46 (69.7%); at station 3a/3p in 14 (51.8%) and 22 (31%); at station 7 in 18 (90%) and 44 (66.7%); at station 8/9 in 11 (55%) and 24 (36.4%) respectively. On the left side (n=60) group 1 vs. group 2 lymphadenectomy resulted at station 4 in 6 (85.7%) and 38 (71.7%); at station 5/6 in 6 (85.7%) and 26 (49%); at station 7 in 6 (85.7%) and 33 (62.3%), and at station 8/9 in 1 (14.3%) and 18 (34%). There were no early deaths and recurrent laryngeal nerve palsy occurred in 1 (0.8%) in group 2. Pathological upstaging (pN1; pN2) was found in 5 patients (17%) in group 1, and 13 (11%) in group 2 (P=0.23). About FS (n=29), formal paraffin histology resulted in 0% of both, false negative and false positive results. CONCLUSIONS Based on our experience, the combination "VM with FS followed by VMPRS in sequence", seems to be effective and offers an alternative approach to improve intraoperative mediastinal staging.
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Affiliation(s)
| | | | | | - Sara Borgianni
- Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy
| | - Roberto Borrelli
- Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy
| | - Giorgia Tancredi
- Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy
| | - Massimo O Jaus
- Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy
| | - Leonardo Politi
- Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy
| | - Camilla E Comin
- Department of Experimental and Clinical Medicine, Section of Surgery, Histopathology and Molecular Pathology, University of Florence, Italy
| | - Luca Voltolini
- Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy
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14
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Zhang M, Wang H, Wu W, Liu D, Li M, Hu Z, Zhang H. Non-intubated simultaneous en bloc resection of pulmonary nodule and rib chondrosarcoma. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:344. [PMID: 27761448 DOI: 10.21037/atm.2016.09.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Adequate surgical resection was required for patients with rib chondrosarcoma. A 61-year-old woman was presented with a palpable chest wall mass. Computed tomography (CT) of the chest revealed an isolated pulmonary nodule about 0.9 cm, and a giant rib tumor about 12 cm × 9 cm which penetrated through the 7th rib into thorax. CT reconstruction and simulated surgery was utilized for disease-free surgical margin (R0 resection), then a simultaneous en bloc resection of pulmonary nodule and rib tumor was performed along with chest wall reconstruction under local anesthesia and intravenous sedation without endotracheal intubation. And the recovery was encouragingly uneventful.
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Affiliation(s)
- Miao Zhang
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou 221009, China
| | - Heng Wang
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou 221009, China
| | - Wenbin Wu
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou 221009, China
| | - Dong Liu
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou 221009, China
| | - Min Li
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou 221009, China
| | - Zhengqun Hu
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou 221009, China
| | - Hui Zhang
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou 221009, China
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15
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Zhang M, Wang H, Liu D, Pan X, Wu W, Hu Z, Zhang H. Non-intubated laparoscopic repair of giant Morgagni's hernia for a young man. J Thorac Dis 2016; 8:E698-701. [PMID: 27621903 DOI: 10.21037/jtd.2016.07.87] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
An asymptomatic patient was admitted as his chest photograph and computed tomography scans showed a giant Morgagni's hernia (MH). And it was repaired by laparoscopic approach under epidural anesthesia without endotracheal intubation. The hernia content of omentum was repositioned back into the abdominal cavity, and the diaphragmatic defect was repaired with composite mesh. Which indicated that non-intubated laparoscopic mesh repair via epidural anesthesia is reliable and satisfactory for MH.
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Affiliation(s)
- Miao Zhang
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou 221009, China
| | - Heng Wang
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou 221009, China
| | - Dong Liu
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou 221009, China
| | - Xuefeng Pan
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou 221009, China
| | - Wenbin Wu
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou 221009, China
| | - Zhengqun Hu
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou 221009, China
| | - Hui Zhang
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou 221009, China
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16
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Dai X, Song P, Zhang B. [Application of Non-intubated Anesthesia in VATS]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:312-6. [PMID: 27215461 PMCID: PMC5973052 DOI: 10.3779/j.issn.1009-3419.2016.05.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
气管插管全麻技术可提高手术安全性,因此在电视胸腔镜手术(video-assisted thoracic surgery, VATS)中得到广泛应用,但气管插管的并发症却无法避免。如何发展一种“整体微创”手术(包括麻醉微损伤),已经成为微创胸外科领域的一个研究热点。随着麻醉管理技术与对手术风险管理的进步,非气管插管技术成功应用于VATS,即采用局部麻醉以维持患者的术中自主通气,术中仅需轻微镇静或者完全清醒的状态下实施VATS,因而又称清醒状态下VATS。此麻醉方式不但减少气管插管的麻醉损伤,而且符合快速康复外科的理念。本文对非气管插管应用在胸外科VATS中的发展简史、麻醉选择、手术优势、手术风险及管理、面临的问题等方面作一综述。
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Affiliation(s)
- Xiaotan Dai
- School of Medicine and Life Sclences, University of Jinan, Jinan 250117, China
| | - Pingping Song
- School of Medicine and Life Sclences, University of Jinan, Jinan 250117, China
| | - Baijiang Zhang
- Shandong Academy of Medical Sciences, Jinan 250117, China
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17
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Irons JF, Martinez G. Anaesthetic considerations for non-intubated thoracic surgery. J Vis Surg 2016; 2:61. [PMID: 29078489 DOI: 10.21037/jovs.2016.02.22] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 02/03/2016] [Indexed: 12/18/2022]
Abstract
General anaesthesia with intubation and single lung ventilation has always been considered essential for thoracic surgery. Over the last decade there has been a huge evolution in thoracic surgery with the development of multiport and uniportal minimally invasive techniques. The development of a non-intubated technique during which thoracic surgery is performed on patients who are spontaneously ventilating awake, under minimal sedation with the aid of local or regional anaesthesia or under general anaesthesia with a supraglottic airway device is winning acceptance as a valid alternative technique. The concept is to allow the creation of a spontaneous pneumothorax as the surgeon enters the chest. This can provide excellent lung isolation without the need for positive pressure ventilation on the dependant lung. Awake and minimal sedation techniques, which avoid the need for general anaesthesia, maintain a more physiological cardiopulmonary and neurological status and avoid postoperative nausea and vomiting. However, general anaesthesia with a supraglottic airway device is the technique that provides a more stable airway and facilitates oxygenation in cases where an unexpected conversion to open thoracotomy in needed. For non-intubated thoracic surgery a regional analgesic technique is essential; nonetheless a 'multimodal' approach to analgesia is recommended. Non-intubated anaesthetic techniques for thoracic surgery are innovative and exciting and drive to reduce the invasiveness of the procedures. We recommend that centres starting out with non-intubated techniques begin by performing minor video-assisted thoracic surgery (VATS) procedures in selected low risk patients. Early elective conversion should be employed in any unexpected surgical difficulty or cardiopulmonary problem during the learning curve to reduce the risk of emergency conversion and complications. Further research is needed to establish which patients benefit more from the technique and what is the real impact on perioperative mortality and morbidity.
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Affiliation(s)
- Joanne Frances Irons
- Department of Anaesthesia and Intensive Care, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Guillermo Martinez
- Department of Anaesthesia and Intensive Care, Papworth Hospital NHS Foundation Trust, Cambridge, UK
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18
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Liu YJ, Hung MH, Hsu HH, Chen JS, Cheng YJ. Effects on respiration of nonintubated anesthesia in thoracoscopic surgery under spontaneous ventilation. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:107. [PMID: 26046048 DOI: 10.3978/j.issn.2305-5839.2015.04.15] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 04/16/2015] [Indexed: 11/14/2022]
Abstract
Thoracoscopic surgery without tracheal intubation [nonintubated video-assisted thoracoscopic surgery (VATS)] is an emerging treatment modality for a wide variety of thoracic procedures. By surgically induced open pneumothorax, the operated lung collapse progressively while the dependent lung is responsible for sufficiency of respiratory function, including oxygenation and ventilation. Encouraging results showed that ventilatory changes and oxygenation could be adequately maintained in major lung resection surgery and in patients with impaired respiratory function. In spite of a relative hypoventilation, mild hypercapnia is inevitable but clinically well tolerated. An understanding the respiratory physiology during surgical pneumothorax, either in awake or sedative status, and an established protocol for conversion into tracheal intubation are essential for patient safety during nonintubated VATS.
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Affiliation(s)
- Ying-Ju Liu
- 1 Department of Anesthesiology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu 30059, Taiwan ; 2 Department of Anesthesiology, 3 Graduate Institute of Clinical Medicine, 4 Division of Thoracic Surgery, Department of Surgery, 5 Department of Traumatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10002, Taiwan
| | - Ming-Hui Hung
- 1 Department of Anesthesiology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu 30059, Taiwan ; 2 Department of Anesthesiology, 3 Graduate Institute of Clinical Medicine, 4 Division of Thoracic Surgery, Department of Surgery, 5 Department of Traumatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10002, Taiwan
| | - Hsao-Hsun Hsu
- 1 Department of Anesthesiology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu 30059, Taiwan ; 2 Department of Anesthesiology, 3 Graduate Institute of Clinical Medicine, 4 Division of Thoracic Surgery, Department of Surgery, 5 Department of Traumatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10002, Taiwan
| | - Jin-Shing Chen
- 1 Department of Anesthesiology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu 30059, Taiwan ; 2 Department of Anesthesiology, 3 Graduate Institute of Clinical Medicine, 4 Division of Thoracic Surgery, Department of Surgery, 5 Department of Traumatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10002, Taiwan
| | - Ya-Jung Cheng
- 1 Department of Anesthesiology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu 30059, Taiwan ; 2 Department of Anesthesiology, 3 Graduate Institute of Clinical Medicine, 4 Division of Thoracic Surgery, Department of Surgery, 5 Department of Traumatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10002, Taiwan
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19
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Navarro-Martínez J, Gálvez C, Rivera-Cogollos MJ, Galiana-Ivars M, Bolufer S, Martínez-Adsuar F. Intraoperative crisis resource management during a non-intubated video-assisted thoracoscopic surgery. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:111. [PMID: 26046052 DOI: 10.3978/j.issn.2305-5839.2015.04.14] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 04/19/2015] [Indexed: 11/14/2022]
Abstract
The management of surgical and medical intraoperative emergencies are included in the group of high acuity (high potential severity of an event and the patient impact) and low opportunity (the frequency in which the team is required to manage the event). This combination places the patient into a situation where medical errors could happen more frequently. Although medical error are ubiquitous and inevitable we should try to establish the necessary knowledge, skills and attitudes needed for effective team performance and to guide the development of a critical event. This strategy would probably reduce the incidence of error and improve decision-making. The way to apply it comes from the application of the management of critical events in the airline industry. Its use in a surgical environment is through the crisis resource management (CRM) principles. The CRM tries to develop all the non-technical skills necessary in a critical situation, but not only that, also includes all the tools needed to prevent them. 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 such as the non-intubated video-assisted thoracoscopic surgery.
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Affiliation(s)
- Jose Navarro-Martínez
- 1 Anesthesiology and Surgical Critical Care Department, 2 Thoracic Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Carlos Gálvez
- 1 Anesthesiology and Surgical Critical Care Department, 2 Thoracic Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - María Jesus Rivera-Cogollos
- 1 Anesthesiology and Surgical Critical Care Department, 2 Thoracic Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - María Galiana-Ivars
- 1 Anesthesiology and Surgical Critical Care Department, 2 Thoracic Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Sergio Bolufer
- 1 Anesthesiology and Surgical Critical Care Department, 2 Thoracic Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Francisco Martínez-Adsuar
- 1 Anesthesiology and Surgical Critical Care Department, 2 Thoracic Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
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20
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Akopov A, Egorov V, Deynega I, Ionov P. Awake video-assisted thoracic surgery in acute infectious pulmonary destruction. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:100. [PMID: 26046041 DOI: 10.3978/j.issn.2305-5839.2015.04.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 04/03/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND Many of thoracic minimally invasive interventions have been proven to be possible without general anesthesia. This article presents results of video-assisted thoracic surgery (VATS) application under local anesthesia in patients with lung abscesses and discusses its indications in detail. METHODS The study involved prospective analysis of treatment outcomes for all acute infectious pulmonary destruction (AIPD) patients undergoing VATS under local anesthesia and sedation since January 1, 2010, till December 31, 2013. Patients with pulmonary destruction cavity at periphery of large size (>5 cm) underwent non-intubated video abscessoscopy (NIVAS). Patients with pyopneumothorax (lung abscess penetration into pleural cavity) underwent non-intubated video thoracoscopy (NIVTS). Indications for NIVAS and NIVTS were as follows: cavity debridement and washing, necrotic sequestra removal, adhesion split, biopsy. All interventions were done under local anesthesia and sedation without trachea intubation and epidural anesthesia. RESULTS Sixty-five enrolled patients had 42 NIVAS and 32 NIVTS interventions, nine patients underwent two surgeries. None of the patients required trachea intubation or epidural anesthesia. In none of our cases with conversion to thoracotomy was required. Post-surgical complications developed after 11 interventions (13%): subcutaneous emphysema (five cases), chest wall phlegmon (three cases), pulmonary bleeding (two cases), and pneumothorax (one case). One patient died due to the main disease progression. In 50 patients NIVAS and NIVTS were done within 5 to 8 days after abscess/pleural cavity draining, while in other 15 patients-immediately prior to draining; both pulmonary bleeding episodes and all cases of chest wall phlegmon took place in the latter group. CONCLUSIONS NIVAS and NIVTS under local anesthesia and sedation are well tolerated by patients, safe and should be used more often in AIPD cases. Timing of NIVAS and NIVTS procedures was found to be of paramount importance for ensuring complete therapeutic effectiveness.
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Affiliation(s)
- Andrey Akopov
- 1 Department of Thoracic Surgery, First Pavlov State Medical University, Saint-Petersburg, Russia ; 2 Department of Thoracic Surgery, City Hospital Nº1, Saint-Petersburg, Russia
| | - Vladimir Egorov
- 1 Department of Thoracic Surgery, First Pavlov State Medical University, Saint-Petersburg, Russia ; 2 Department of Thoracic Surgery, City Hospital Nº1, Saint-Petersburg, Russia
| | - Igor Deynega
- 1 Department of Thoracic Surgery, First Pavlov State Medical University, Saint-Petersburg, Russia ; 2 Department of Thoracic Surgery, City Hospital Nº1, Saint-Petersburg, Russia
| | - Pavel Ionov
- 1 Department of Thoracic Surgery, First Pavlov State Medical University, Saint-Petersburg, Russia ; 2 Department of Thoracic Surgery, City Hospital Nº1, Saint-Petersburg, Russia
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Galvez C, Bolufer S, Navarro-Martinez J, Lirio F, Corcoles JM, Rodriguez-Paniagua JM. Non-intubated video-assisted thoracic surgery management of secondary spontaneous pneumothorax. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:104. [PMID: 26046045 DOI: 10.3978/j.issn.2305-5839.2015.04.24] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 04/23/2015] [Indexed: 11/14/2022]
Abstract
Secondary spontaneous pneumothorax (SSP) is serious entity, usually due to underlying disease, mainly chronic obstructive pulmonary disease (COPD). Its morbidity and mortality is high due to the pulmonary compromised status of these patients, and the recurrence rate is almost 50%, increasing mortality with each episode. For persistent or recurrent SSP, surgery under general anesthesia (GA) and mechanical ventilation (MV) with lung isolation is the gold standard, but ventilator-induced damages and dependency, and postoperative pulmonary complications are frequent. In the last two decades, several groups have reported successful results with non-intubated video-assisted thoracic surgery (NI-VATS) with thoracic epidural anesthesia (TEA) and/or local anesthesia under spontaneous breathing. Main benefits reported are operative time, operation room time and hospital stay reduction, and postoperative respiratory complications decrease when comparing to GA, thus encouraging for further research in these moderate to high risk patients many times rejected for the standard regimen. There are also reports of special situations with satisfactory results, as in contralateral pneumonectomy and lung transplantation. The aim of this review is to collect, analyze and discuss all the available evidence, and seek for future lines of investigation.
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Affiliation(s)
- Carlos Galvez
- 1 Thoracic Surgery Service, 2 Anethesiologist and Surgical Critical Care Service, University General Hospital of Alicante, C/Pintor Baeza 12, 03010, Alicante, Spain ; 3 Thoracic Surgery Service, Vinalopo Hospital, C/Tonico Sansano Mora 14, 03293 Elche, Alicante, Spain ; 4 Thoracic Surgery, Alicante, Spain
| | - Sergio Bolufer
- 1 Thoracic Surgery Service, 2 Anethesiologist and Surgical Critical Care Service, University General Hospital of Alicante, C/Pintor Baeza 12, 03010, Alicante, Spain ; 3 Thoracic Surgery Service, Vinalopo Hospital, C/Tonico Sansano Mora 14, 03293 Elche, Alicante, Spain ; 4 Thoracic Surgery, Alicante, Spain
| | - Jose Navarro-Martinez
- 1 Thoracic Surgery Service, 2 Anethesiologist and Surgical Critical Care Service, University General Hospital of Alicante, C/Pintor Baeza 12, 03010, Alicante, Spain ; 3 Thoracic Surgery Service, Vinalopo Hospital, C/Tonico Sansano Mora 14, 03293 Elche, Alicante, Spain ; 4 Thoracic Surgery, Alicante, Spain
| | - Francisco Lirio
- 1 Thoracic Surgery Service, 2 Anethesiologist and Surgical Critical Care Service, University General Hospital of Alicante, C/Pintor Baeza 12, 03010, Alicante, Spain ; 3 Thoracic Surgery Service, Vinalopo Hospital, C/Tonico Sansano Mora 14, 03293 Elche, Alicante, Spain ; 4 Thoracic Surgery, Alicante, Spain
| | - Juan Manuel Corcoles
- 1 Thoracic Surgery Service, 2 Anethesiologist and Surgical Critical Care Service, University General Hospital of Alicante, C/Pintor Baeza 12, 03010, Alicante, Spain ; 3 Thoracic Surgery Service, Vinalopo Hospital, C/Tonico Sansano Mora 14, 03293 Elche, Alicante, Spain ; 4 Thoracic Surgery, Alicante, Spain
| | - Jose Manuel Rodriguez-Paniagua
- 1 Thoracic Surgery Service, 2 Anethesiologist and Surgical Critical Care Service, University General Hospital of Alicante, C/Pintor Baeza 12, 03010, Alicante, Spain ; 3 Thoracic Surgery Service, Vinalopo Hospital, C/Tonico Sansano Mora 14, 03293 Elche, Alicante, Spain ; 4 Thoracic Surgery, Alicante, Spain
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