1
|
Re Cecconi E, Mangiameli G, De Simone M, Cioffi U, Marulli G, Testori A. Vats lobectomy for lung cancer. What has been the evolution over the time? Front Oncol 2024; 13:1268362. [PMID: 38260828 PMCID: PMC10800971 DOI: 10.3389/fonc.2023.1268362] [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: 07/27/2023] [Accepted: 12/06/2023] [Indexed: 01/24/2024] Open
Abstract
Video assisted thoracic surgery (VATS) lobectomy is the treatment of choice for early-stage lung cancer. It is safe and effective compared to open surgery, as demonstrated by a large body of scientific evidence over the last few decades. VATS lobectomy's evolution was driven by the need to decrease post-operative pain by reducing the extent of surgical accesses, maintaining the same oncological efficacy of open lobectomy with less invasiveness. VATS lobectomy just turned 30 years old, evolving and changing significantly from its origins. The aim of this mini review is to retrace the history, starting from a multiport approach to a single port approach. At the end of this mini review, we will discuss the advanced and the future challenges of the technique that has revolutionized thoracic surgery.
Collapse
Affiliation(s)
- Emanuela Re Cecconi
- Division of Thoracic Surgery, Department of Thoracic Surgery, Tor Vergata University Polyclinic, Rome, Italy
| | - Giuseppe Mangiameli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | - Giuseppe Marulli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alberto Testori
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| |
Collapse
|
2
|
Alagoz A, Findik G, Sazak H, Demiroz SM, Baldemir R, Ulger G, Zengin M. Non-intubated video-assisted thoracoscopic surgery under combination of erector spinae plane block and thoracic paravertebral block. BMC Anesthesiol 2022; 22:99. [PMID: 35387585 PMCID: PMC8985295 DOI: 10.1186/s12871-022-01634-4] [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: 11/26/2021] [Accepted: 03/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background The use of anesthetics and analgesic drugs and techniques in combination yields a multimodal effect with increased efficiency. In this case series, we aimed to evaluate the anesthetic effect of the thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) combination in patients, who underwent non-intubated video-assisted thoracoscopic surgery (NIVATS). Methods Medical records of 16 patients, who underwent NIVATS for wedge resection under the combination of ESPB and TPVB were reviewed retrospectively. Demographic data of patients, duration of the sensory block, amount of the anesthetic agent used for premedication and sedo-analgesia, any presence of perioperative cough, operative times, postoperative visual analog scale (VAS) scores in the postoperative follow-up period, the need for additional analgesia, and patient satisfaction were reviewed. Results Of the patients included in the study, 12 were men and 4 were women. The mean age was 48.6 years and the mean BMI was 24.7 kg/m2. The mean time needed for the achievement of the sensorial block was 14 min and the mean skin-to-skin operative time was 21.4 min. During the procedure, patients received 81.5 ± 27.7 mg of propofol and 30 ± 13.6 micrograms of remifentanil infusions, respectively. The mean dose of ketamine administered in total was 58.1 ± 12.2 mg. Only 2 patients needed an extra dose of remifentanil because of recurrent cough. No patients developed postoperative nausea vomiting. During the first 24 h, the VAS static scores of the patients were 3 and below, while VAS dynamic scores were 4 and below. Morphine consumption in the first postoperative 24 h was 13.2 mg. Conclusions In conclusion, combined ESPB and TPVB with added intravenous sedo-analgesia in the presence of good cooperation between the surgical team and the anesthesiologist in the perioperative period can provide optimal surgical conditions including the prevention of cough in NIVATS. It is not sufficient to state that this combination is superior to alone ESPB or alone TPVB, as it is a preliminary study with a limited number of cases.
Collapse
Affiliation(s)
- Ali Alagoz
- Department of Anesthesiology and Reanimation, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey.
| | - Gokturk Findik
- Department of Thoracic Surgery, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Hilal Sazak
- Department of Anesthesiology and Reanimation, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | | | - Ramazan Baldemir
- Department of Anesthesiology and Reanimation, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Gulay Ulger
- Department of Anesthesiology and Reanimation, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Musa Zengin
- Department of Anesthesiology and Reanimation, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Rosboch GL, Giunta F, Ceraolo E, Piccioni F, Guerrera F, Balzani E, Pardolesi A, Ferrari PA, Tosi D, Rispoli M, Gregorio GD, Corso RM, Crisci R. Italian survey on non-intubated thoracic surgery: results from INFINITY group. BMC Anesthesiol 2022; 22:2. [PMID: 34979933 PMCID: PMC8722187 DOI: 10.1186/s12871-021-01514-3] [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: 04/30/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background Non-Intubated Thoracic Surgery (NITS) is becoming increasingly adopted all over the world. Although it is mainly used for pleural operations,, non-intubated parenchymal lung surgery has been less frequently reported. Recently, NITS utilization seems to be increased also in Italy, albeit there are no multi-center studies confirming this finding. The objective of this survey is to assess quantitatively and qualitatively the performance of NITS in Italy. Methods In 2018 a web-based national survey on Non-Intubated management including both thoracic surgeons and anesthesiologists was carried out. Reference centers have been asked to answer 32 questions. Replies were collected from June 26 to November 31, 2019. Results We raised feedbacks from 95% (55/58) of Italian centers. Seventy-eight percent of the respondents perform NITS but only 38% of them used this strategy for parenchymal surgery. These procedures are more frequently carried out in patients with severe comorbidities and/or with poor lung function. Several issues as obesity, previous non-invasive ventilation and/or oxygen therapy are considered contraindications to NITS. The regional anesthesia technique most used to provide intra- and postoperative analgesia was the paravertebral block (37%). Conversion to general anesthesia is not anecdotal (31% of answerers). More than half of the centers believed that NITS may reduce postoperative intensive care unit admissions. Approximately a quarter of the centers are conducting trials on NITS and, three quarters of the respondent suppose that the number of these procedures will increase in the future. Conclusions There is a growing interest in Italy for NITS and this survey provides a clear view of the national management framework of these procedures. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01514-3.
Collapse
Affiliation(s)
- Giulio Luca Rosboch
- Department of Anesthesia and Intensive Care, AOU Città della Salute e della Scienza, Torino, Italy
| | - Federica Giunta
- Department of Surgical Science, Anesthesia and Intensive Care Unit, University of Turin, Via Verdi, 8 -, 10124, Torino, Italy
| | - Edoardo Ceraolo
- Department of Anesthesia and Intensive Care, AOU Città della Salute e della Scienza, Torino, Italy
| | - Federico Piccioni
- Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Guerrera
- Department of Surgical Sciences, Thoracic Surgery Unit, University of Turin, Torino, Italy
| | - Eleonora Balzani
- Department of Surgical Science, Anesthesia and Intensive Care Unit, University of Turin, Via Verdi, 8 -, 10124, Torino, Italy.
| | - Alessandro Pardolesi
- Division of Thoracic Surgery, Foundation IRCCS National Cancer Institute of Milan, Milan, Italy
| | - Paolo Albino Ferrari
- Division of Thoracic Surgery, A. Businco Cancer Center, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Davide Tosi
- Division of Thoracic Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Rispoli
- Unit of Anestesiology and Intensive Care, Vincenzo Monaldi Hospital, Naples, Italy
| | - Giudo Di Gregorio
- Unit of Anestesiology and Intensive Care, ULSS6 Euganea Ospedale di Cittadella (PD), Padova, Italy
| | - Ruggero Massimo Corso
- Department of Surgery, Anesthesia and Intensive Care Section, "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy
| | - Roberto Crisci
- Thoracic Surgery, University of L'Aquila, L'Aquila, Italy
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
He J, Liang H, Wang W, Akopov A, Aiolfi A, Ang KL, Bertolaccini L, Cai K, Cao Q, Chen B, Chen C, Chen C, Chen D, Chen F, Chen J, Chen L, Chen M, Chen Y, Chen Z, Cheng C, Cui D, Cui F, Dai T, Dong Q, Ferrari PA, Flores RM, Fu J, Funaki S, Froudarakis ME, Gan X, Geng M, Guo J, Guo Q, Han Y, He J, He K, Hirai K, Hu J, Hu S, Huang J, Huang J, Jiang W, Kim KS, Kiss G, Kong F, Lan L, Leng X, Li B, Li G, Li H, Li H, Li H, Li J, Li X, Li S, Li Y, Li Z, Liang Y, Liang L, Liang W, Liao Y, Lin W, Lin X, Liu H, Liu H, Liu J, Liu J, Liu X, Liu Z, Lu X, Luo Q, Mao N, Pan Q, Pang D, Peng J, Peng J, Pompeo E, Qian R, Qiao K, Redwan B, Sang Z, Shao W, Shen J, Shen W, Sung SW, Tang W, Wang T, Wang G, Wang H, Wang H, Wang J, Wang W, Wang Y, Wang Z, Wei L, Wei W, Wu H, Wu J, Xia Z, Xu C, Xu E, Xu H, Xu N, Xu Q, Xu R, Xu S, Yang C, Yang H, Yang S, Yi J, Zhang G, Zhang H, Zhang J, Zhang M, Zhang X, Zhang Y, Zhang Z, Zhang Z, Zhao H, Zhao J, Zhao X, Zhou J, Zhou Y, Zhu C, Zhu S, Zhu X, Cui J, Yan Y, Chen KN. Tubeless video-assisted thoracic surgery for pulmonary ground-glass nodules: expert consensus and protocol (Guangzhou). Transl Lung Cancer Res 2021; 10:3503-3519. [PMID: 34584853 PMCID: PMC8435391 DOI: 10.21037/tlcr-21-663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/23/2021] [Indexed: 12/13/2022]
Affiliation(s)
- 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
| | - 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
| | - 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
| | - Andrey Akopov
- Department of Thoracic Surgery, First Pavlov State Medical University, Saint-Petersburg, Russia
| | - Alberto Aiolfi
- Division of Minimally Invasive Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
| | - Keng-Leong Ang
- Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Kaican Cai
- Department of Thoracic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, China
| | - Qingdong Cao
- Department of Thoracic Surgery, the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Baojun Chen
- Department of Thoracic Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Donglai Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fengxia Chen
- Department of Thoracic Surgery, Hainan General Hospital, Hainan, China
| | - Jun Chen
- Lung Cancer Department, Tianjin General Hospital, Tianjin Medical University, Tianjin, China
| | - Lei Chen
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Mingwu Chen
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yongbing Chen
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Soochow, China
| | - Zhuxing Chen
- 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
| | - Chao Cheng
- Department of Thoracic Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dong Cui
- Department of Thoracic Surgery, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Fei Cui
- 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
| | - Tianyang Dai
- Department of Thoracic Surgery, Southwest Medical University Affiliated Hospital, Luzhou, China
| | - Qinglong Dong
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Paolo A Ferrari
- Division of Thoracic Surgery, Oncology Hospital "A. Businco", A.R.N.A.S. "G. Brotzu", Cagliari, Italy
| | - Raja M Flores
- Department of Thoracic Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Junke Fu
- Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Soichiro Funaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Marios E Froudarakis
- Department of Pneumonology and Thoracic Oncology, North Hospital, University Hospital of Saint-Etienne, St-Etienne, France
| | - Xiangfeng Gan
- Department of Thoracic Surgery, the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Mingfei Geng
- Department of Thoracic Surgery, Anyang Tumour Hospital, Anyang, China
| | - Jialong Guo
- Department of Cardiothoracic Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Qiang Guo
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China
| | - Yongtao Han
- Division of Thoracic Surgery, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Jintao He
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Kaiming He
- Department of Thoracic Surgery, Southwest Medical University Affiliated Hospital, Luzhou, China
| | - Kyoji Hirai
- Division of Thoracic Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Jian Hu
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shuqiao Hu
- Department of Thoracic Surgery, Longyan City First Hospital, Longyan, China
| | - Jian Huang
- Department of Thoracic Surgery, Maoming People's Hospital, Maoming, China
| | - Jun Huang
- 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
| | - Wenfa Jiang
- Department of Thoracic Surgery, Ganzhou People's Hospital, Ganzhou, China
| | - Kyung Soo Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Gabor Kiss
- Department of Cardiovascular and Thoracic Surgery, Anaesthesia and Surgical Intensive Care, University Hospital Felix Guyon, Saint Denis, Reunion Island, France
| | - Fanyi Kong
- Department of Thoracic Surgery, Cangzhou Central Hospital, Cangzhou, China
| | - Lan Lan
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xuefeng Leng
- Division of Thoracic Surgery, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Bin Li
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, China
| | - Gaofeng Li
- 2nd Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hefei Li
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China
| | - Heng Li
- 2nd Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jiwei Li
- Department of Thoracic Surgery, Zhengzhou Key Laboratory for Surgical Treatment for End-stage Lung Disease, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, China
| | - Xiaoqiang Li
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Shuben Li
- 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
| | - Yinfen Li
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhuoyi Li
- 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 Liang
- Department of Cardiothoracic Surgery, Zhongshan City People's Hospital, Zhongshan, China
| | - Lixia Liang
- Department of Anesthesia, the First Affiliated Hospital of 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
| | - Yongde Liao
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wanli Lin
- Department of Thoracic Surgery, Gaozhou People's Hospital, Gaozhou, China
| | - Xu Lin
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hongxu Liu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Hui Liu
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jixian Liu
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, 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
| | - Xiang Liu
- Department of Thoracic Surgery, Second Affiliated Hospital of the University of South China, Hengyang, China
| | - Zihao Liu
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xingzhao Lu
- Department of Cardiothoracic Surgery, Dongguan People's Hospital, Dongguan, China
| | - Qingquan Luo
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Naiquan Mao
- Department of Thoracic Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Qi Pan
- Department of Thoracic Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Dazhi Pang
- Department of Thoracic Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Jun Peng
- Department of Thoracic Surgery, the First People's Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Jun Peng
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Eugenio Pompeo
- Department of Thoracic Surgery, Policlinico Tor Vergata University of Rome, Rome, Italy
| | - Rulin Qian
- Department of Thoracic Surgery, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Kun Qiao
- Department of Thoracic Surgery, Third People's Hospital of Shenzhen, Shenzhen, China
| | - Bassam Redwan
- Department of Thoracic Surgery, Klinik am Park, Klinikum Westfalen, Lünen, Germany
| | - Zi Sang
- Department of Thoracic Surgery, Anyang Tumour Hospital, Anyang, China
| | - Wenlong Shao
- 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
| | - Jianfei Shen
- Department of Thoracic Surgery, Taizhou Hospital, Taizhou, China
| | - Weiyu Shen
- Department of Thoracic Surgery, Ningbo medical center LIHUILI Hospital, Ningbo, China
| | - Sook-Whan Sung
- Thoracic and Cardiovascular Surgery, Ewha Womens University Seoul Hospital, Seoul, Korea
| | - Wenfang Tang
- Department of Cardiothoracic Surgery, Zhongshan City People's Hospital, Zhongshan, China
| | - Tianhu Wang
- Department of Thoracic Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guangsuo Wang
- Department of Thoracic Surgery, People's Hospital of Shenzhen, Shenzhen, China
| | - Haitao Wang
- Department of Thoracic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Huien Wang
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, China
| | - Jiyong Wang
- Department of Cardiothoracic, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wen Wang
- Department of Cardio-Thoracic Surgery, Hunan Provincial People's Hospital and The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Yongyong Wang
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Soochow, China
| | - Zhenyuan Wang
- Department of Thoracic Surgery, The People's Hospital of Liaoning Province, Shenyang, China
| | - Li Wei
- Department of Thoracic Surgery, Zhengzhou Key Laboratory for Surgical Treatment for End-stage Lung Disease, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, China
| | - Wei Wei
- Department of Thoracic Surgery, Huizhou Municipal Central Hospital, Huizhou, China
| | - Hao Wu
- Department of Thoracic Surgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Jie Wu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Zhaohua Xia
- Department of Thoracic Surgery, Third People's Hospital of Shenzhen, Shenzhen, China
| | - Chenyang Xu
- Department of Thoracic Surgery, Ganzhou People's Hospital, Ganzhou, China
| | - Enwu Xu
- General Hospital of Southern Theater Command, PLA, Guangzhou, China
| | - Hai Xu
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Ning Xu
- Department of Thoracic Surgery, Anhui Chest Hospital, Hefei, China
| | - Quan Xu
- Department of Thoracic Surgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Rongyu Xu
- Department of Thoracic Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China
| | - Shun Xu
- Department of Thoracic Surgery, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Chaokun Yang
- Department of Thoracic Surgery, The Second Peoples' Hospital of Yibin, Yibin, China
| | - Hanyu Yang
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shengli Yang
- Department of Thoracic Surgery, The First People's Hospital of Foshan, Foshan, China
| | - Jun Yi
- Department of Thoracic and Cardiovascular Surgery, The First People's Hospital of Jingmen, Jingmen, China
| | - Guangjian Zhang
- Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hao Zhang
- Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jia Zhang
- Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Man Zhang
- Department of Thoracic Surgery, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Xiao Zhang
- Department of Thoracic Surgery, The Affiliated Luoyang Central Hospital of Zhengzhou University, Luoyang, China
| | - Yajie Zhang
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhe Zhang
- Department of Thoracic Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Zhifeng Zhang
- Department of Thoracic Surgery, Jieyang People's Hospital, Jieyang, China
| | - Honglin Zhao
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jian Zhao
- Department of Chest Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Xiaodong Zhao
- Department of Thoracic Surgery, the Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Jianping Zhou
- Department of Cardiothoracic Surgery, Dongguan People's Hospital, Dongguan, China
| | - Yanran Zhou
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chengchu Zhu
- Department of Thoracic Surgery, Taizhou Hospital, Taizhou, China
| | - Shaojin Zhu
- Department of Thoracic Surgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, China
| | - Xinhai Zhu
- Department of Thoracic Surgery, Zhejiang Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Jian Cui
- Department of Thoracic Surgery, The Fourth Affiliated Hospital of Harbin Medical University L, Harbin, China
| | - Yubo Yan
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Ke-Neng Chen
- Department of Thoracic Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| |
Collapse
|
7
|
Guerrera F, Costardi L, Rosboch GL, Lyberis P, Ceraolo E, Solidoro P, Filippini C, Verri G, Brazzi L, Albera C, Ruffini E. Awake or intubated surgery in diagnosis of interstitial lung diseases? A prospective study. ERJ Open Res 2021; 7:00630-2020. [PMID: 34235209 PMCID: PMC8255540 DOI: 10.1183/23120541.00630-2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 04/29/2021] [Indexed: 11/21/2022] Open
Abstract
Background Risks associated with video-assisted surgical lung biopsy (VASLB) for interstitial lung disease (ILD) with endotracheal intubation and mechanical ventilation are not nil. Awake video-assisted surgical lung biopsy (Awake-VASLB) has been proposed as a method to obtain a precise diagnosis in several different thoracic diseases. Objectives To compare clinical outcomes of Awake-VASLB and Intubated-VASLB in patients with suspected ILDs. Methods From June 2016 to February 2020, all patients submitted to elective VASLB for suspected ILD were included. Differences in outcomes between Awake-VASLB and Intubated-VASLB were assessed through univariable, multivariable-adjusted, and a propensity score-matched analysis. Results Awake-VASLB was performed in 66 out of 100 patients, while 34 underwent Intubated-VASLB. The Awake-VASLB resulted in a lower post-operative morbidity (OR 0.025; 95% CI 0.001–0.35; p=0.006), less unexpected intensive care unit admission, less need for rescue therapy for pain, a reduced surgical and anaesthesiologic time, a reduced chest drain duration, and a lower post-operative length of stay. Conclusion Awake-VASLB in patients affected by ILD is feasible and seems safer than Intubated-VASLB. Awake surgical lung biopsy in patients affected by ILD is feasible and safer than intubated surgical lung biopsyhttps://bit.ly/2SnMATh
Collapse
Affiliation(s)
- Francesco Guerrera
- Dept of Surgical Science, University of Torino, Turin, Italy.,Dept of Thoracic Surgery, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy.,These authors contributed equally to this work
| | - Lorena Costardi
- Dept of Surgical Science, University of Torino, Turin, Italy.,Dept of Thoracic Surgery, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy.,These authors contributed equally to this work
| | - Giulio L Rosboch
- Dept of Anesthesia, Intensive Care and Emergency, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy.,These authors contributed equally to this work
| | - Paraskevas Lyberis
- Dept of Thoracic Surgery, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Edoardo Ceraolo
- Dept of Anesthesia, Intensive Care and Emergency, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Paolo Solidoro
- Division of Pulmonology, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy.,Dept of Medical Sciences, University of Torino, Turin, Italy
| | | | - Giulia Verri
- Division of Pulmonology, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Luca Brazzi
- Dept of Surgical Science, University of Torino, Turin, Italy.,Dept of Anesthesia, Intensive Care and Emergency, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Carlo Albera
- Division of Pulmonology, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy.,Dept of Medical Sciences, University of Torino, Turin, Italy
| | - Enrico Ruffini
- Dept of Surgical Science, University of Torino, Turin, Italy.,Dept of Thoracic Surgery, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Non-intubated video-assisted thoracoscopic bullectomy by paravetebral block and sedation. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:133-134. [PMID: 33768995 PMCID: PMC7970083 DOI: 10.5606/tgkdc.dergisi.2021.19367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 02/26/2020] [Indexed: 01/07/2023]
|
11
|
Starke H, Zinne N, Leffler A, Zardo P, Karsten J. Developing a minimally-invasive anaesthesiological approach to non-intubated uniportal video-assisted thoracoscopic surgery in minor and major thoracic surgery. J Thorac Dis 2020; 12:7202-7217. [PMID: 33447409 PMCID: PMC7797846 DOI: 10.21037/jtd-20-2122] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Non-intubated uniportal video-assisted thoracoscopic surgery (niVATS) is a novel approach to major and minor lung resection. It benefits from a holistic anesthesiological concept with adequate pain relief and sedation in a minimal-invasive setup allowing thoracic procedures under spontaneous breathing. At present no anesthesiological gold standard for niVATS exists. The primary aim of our retrospective observational study was to evaluate feasibility and safety of minimally invasive niVATS for both minor and major pulmonary resections at our institution. Methods All 88 consecutive patients scheduled for niVATS minor or major thoracic procedures were included into the study. Anaesthesia was performed according to a departmental niVATS algorithm including both regional anaesthesia and sedation. Patient characteristics and early outcome data including intraoperative and postoperative findings were compared between groups. Prediction scores for postoperative complications (LAS VEGAS, ARISCAT, ThRCRI) were calculated and compared. Results No early mortality and a low overall morbidity rate of 28.4% were encountered. Conversion to orotracheal intubation was required in 6.8% of all cases. Postoperative pulmonary complications occurred in 15.9% of total cases and were lower than predicted by both LAS VEGAS and ARISCAT respectively. Cardiac complications were found in 1.1% and lower than predicted by ThRCRI. A persistent air leak occurred in 11.4% of total cases and was significantly higher in major resection. Postoperative chest tube duration and hospital length of stay in the major resection group exceeded times reported by other groups. Conclusions niVATS appears to be safe in both minor and major thoracic procedures. A minimally invasive anaesthesiological approach foregoing central iv lines, arterial blood pressure measurement and urinary catheterization is feasible. Our niVATS protocol appears to be a viable alternative for both minor and major thoracic procedures in selected patients.
Collapse
Affiliation(s)
- Henning Starke
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Norman Zinne
- Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Germany
| | - Andreas Leffler
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Patrick Zardo
- Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Germany
| | - Jan Karsten
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| |
Collapse
|
12
|
Liu L, Wu W, Gong L, Zhang M. Contralateral spontaneous rupture of the esophagus following severe emesis after non-intubated pulmonary wedge resection. J Cardiothorac Surg 2020; 15:285. [PMID: 33004053 PMCID: PMC7528247 DOI: 10.1186/s13019-020-01321-w] [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: 06/22/2020] [Accepted: 09/21/2020] [Indexed: 12/12/2022] Open
Abstract
Background Non-intubated thoracoscopic lung surgery has been reported to be technically feasible and safe. Spontaneous rupture of the esophagus, also known as Boerhaave’s syndrome (BS), is rare after chest surgery. Case presentation A 60-year-old female non-smoker underwent non-intubated uniportal thoracoscopic wedge resection for a pulmonary nodule. Ultrasound-guided serratus anterior plane block was utilized for postoperative analgesia. However, the patient suffered from severe emesis, chest pain and dyspnea 6 h after the surgery. Emergency chest x-ray revealed right-sided hydropneumothorax. BS was diagnosed by chest tube drainage and computed tomography. Besides antibiotics and tube feeding, a naso-leakage drainage tube was inserted into the right thorax for pleural evacuation. Finally, the esophagus was healed 40d after the conservative treatment. Conclusions Perioperative antiemetic therapy is an indispensable item of fast-track surgery. Moreover, BS should be kept in mind when the patients complain of chest distress following emesis after thoracic surgery.
Collapse
Affiliation(s)
- Lei Liu
- Institute of Digestive Disease, China Three Gorges University, Yichang, China.,Department of Gastroenterology, Yichang Central People's Hospital, Yichang, China
| | - Wenbin Wu
- Department of Surgery, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, China
| | - Longbo Gong
- Department of Surgery, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, China
| | - Miao Zhang
- Department of Surgery, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, China.
| |
Collapse
|
13
|
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.
Collapse
|
14
|
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, Ambrogi V, Elkhouly AG, Sung SW, Ang K. Expert consensus on tubeless video-assisted thoracoscopic surgery (Guangzhou). J Thorac Dis 2019; 11:4101-4108. [PMID: 31737292 DOI: 10.21037/jtd.2019.10.04] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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
| | - Vincenzo Ambrogi
- Department of Surgery and Experimental Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Ahmed G Elkhouly
- Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Sook Whan Sung
- Department of Thoracic & Cardiovascular Surgery, Ewha Womens University Seoul Hospital, Gangseo, Seoul, Republic of Korea
| | - Keng Ang
- Department of Thoracic Surgery, Nottingham City Hospital and Glenfield Hospital, Leicester, UK
| |
Collapse
|
15
|
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
| |
Collapse
|
16
|
Lirio F, Galvez C, Bolufer S, Corcoles JM, Gonzalez-Rivas D. Tubeless major pulmonary resections. J Thorac Dis 2018; 10:S2664-S2670. [PMID: 30345103 DOI: 10.21037/jtd.2018.06.48] [Citation(s) in RCA: 12] [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
From its inception, cutting edge minimally invasive thoracic surgery has pursued to barely produce patient perturbation. Although state of the art techniques such as uniportal approach have achieved a remarkable reduction in postoperative morbidity, there is still a way to go in patient comfort. A new 'tubeless' concept has surfaced as an alternative to double-lumen intubation with general anaesthesia combining non-intubated spontaneous breathing video-assisted thoracic surgery (VATS) surgery under loco-regional blockade with the avoidance of central line, epidural or urinary catheter and chest tube in selected patients. Those procedures combine the most evolved and less invasive techniques in anaesthesia, video-assisted surgery and perioperative care to cause the least trauma and allow for faster recovery. Non-intubated thoracic surgery used to rise some concerns regarding spontaneous breathing collapse, oxygenation, cough reflex triggering and mediastinal shift. Today, experienced teams in high-volume centers have proven non-intubated major lung resections are feasible and safe once those drawbacks have been overcome with the proper techniques and extensive previous expertise in VATS. Tubeless thoracic surgery is currently evolving, challenging former exclusion criteria and expanding indications to major lung resections or even tracheal and carinal resections to provide better intraoperative status and promote minimal need for recovery.
Collapse
Affiliation(s)
- Francisco Lirio
- Department of Thoracic Surgery, Marina Salud Hospital, Denia, Spain
| | - Carlos Galvez
- Department of Thoracic Surgery, University General Hospital, Alicante, Spain
| | - Sergio Bolufer
- Department of Thoracic Surgery, University General Hospital, Alicante, Spain
| | | | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Coruña University Hospital and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain.,Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| |
Collapse
|
17
|
Umari M, Falini S, Segat M, Zuliani M, Crisman M, Comuzzi L, Pagos F, Lovadina S, Lucangelo U. Anesthesia and fast-track in video-assisted thoracic surgery (VATS): from evidence to practice. J Thorac Dis 2018; 10:S542-S554. [PMID: 29629201 PMCID: PMC5880994 DOI: 10.21037/jtd.2017.12.83] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 12/11/2017] [Indexed: 12/18/2022]
Abstract
In thoracic surgery, the introduction of video-assisted thoracoscopic techniques has allowed the development of fast-track protocols, with shorter hospital lengths of stay and improved outcomes. The perioperative management needs to be optimized accordingly, with the goal of reducing postoperative complications and speeding recovery times. Premedication performed in the operative room should be wisely administered because often linked to late discharge from the post-anesthesia care unit (PACU). Inhalatory anesthesia, when possible, should be preferred based on protective effects on postoperative lung inflammation. Deep neuromuscular blockade should be pursued and carefully monitored, and an appropriate reversal administered before extubation. Management of one-lung ventilation (OLV) needs to be optimized to prevent not only intraoperative hypoxemia but also postoperative acute lung injury (ALI): protective ventilation strategies are therefore to be implemented. Locoregional techniques should be favored over intravenous analgesia: the thoracic epidural, the paravertebral block (PVB), the intercostal nerve block (ICNB), and the serratus anterior plane block (SAPB) are thoroughly reviewed and the most common dosages are reported. Fluid therapy needs to be administered critically, to avoid both overload and cardiovascular compromisation. All these practices are analyzed singularly with the aid of the most recent evidences aimed at the best patient care. Finally, a few notes on some of the latest trends in research are presented, such as non-intubated video-assisted thoracoscopic surgery (VATS) and intravenous lidocaine.
Collapse
Affiliation(s)
- Marzia Umari
- Department of Perioperative Medicine, Intensive Care, and Emergency, Cattinara University Hospital, Trieste, Italy
| | - Stefano Falini
- Department of Perioperative Medicine, Intensive Care, and Emergency, Cattinara University Hospital, Trieste, Italy
| | - Matteo Segat
- Department of Perioperative Medicine, Intensive Care, and Emergency, Cattinara University Hospital, Trieste, Italy
| | - Michele Zuliani
- Department of Perioperative Medicine, Intensive Care, and Emergency, Cattinara University Hospital, Trieste, Italy
| | - Marco Crisman
- Department of Perioperative Medicine, Intensive Care, and Emergency, Cattinara University Hospital, Trieste, Italy
| | - Lucia Comuzzi
- Department of Perioperative Medicine, Intensive Care, and Emergency, Cattinara University Hospital, Trieste, Italy
| | - Francesco Pagos
- Department of Perioperative Medicine, Intensive Care, and Emergency, Cattinara University Hospital, Trieste, Italy
| | - Stefano Lovadina
- Department of General and Thoracic Surgery, Cattinara University Hospital, Trieste, Italy
| | - Umberto Lucangelo
- Department of Perioperative Medicine, Intensive Care, and Emergency, Cattinara University Hospital, Trieste, Italy
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
Hsiao CH, Chen KC, Chen JS. Modified single-port non-intubated video-assisted thoracoscopic decortication in high-risk parapneumonic empyema patients. Surg Endosc 2016; 31:1719-1727. [PMID: 27519590 DOI: 10.1007/s00464-016-5164-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/30/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Parapneumonic empyema patients with coronary artery disease and reduced left ventricular ejection fraction are risky to receive surgical decortication under general anesthesia. Non-intubated video-assisted thoracoscopy surgery is successfully performed to avoid complications of general anesthesia. We performed single-port non-intubated video-assisted flexible thoracoscopy surgery in an endoscopic center. In this study, the possible role of our modified surgery to treat fibrinopurulent stage of parapneumonic empyema with high operative risks is investigated. METHODS We retrospectively reviewed fibrinopurulent stage of parapneumonic empyema patients between July 2011 and June 2014. Thirty-three patients with coronary artery disease and reduced left ventricular ejection fraction were included in this study. One group received tube thoracostomy, and the other group received single-port non-intubated video-assisted flexible thoracoscopy surgery decortication. Patient demographics, characteristics, laboratory findings, etiology, and treatment outcomes were compared. RESULTS Mean age of 33 patients (24 males, 9 females) was 76.2 ± 9.7 years. Twelve patients received single-port non-intubated video-assisted flexible thoracoscopy surgery decortication, and 21 patients received tube thoracostomy. Visual analog scale scores on postoperative first hour and first day were not significantly different in two groups (p value = 0.5505 and 0.2750, respectively). Chest tube drainage days, postoperative fever subsided days, postoperative hospital days, and total length of stay were significantly short in single-port non-intubated video-assisted flexible thoracoscopy surgery decortication (p value = 0.0027, 0.0001, 0.0009, and 0.0065, respectively). Morbidities were low, and mortality was significantly low (p value = 0.0319) in single-port non-intubated video-assisted flexible thoracoscopy surgery decortication. CONCLUSIONS Single-port non-intubated video-assisted flexible thoracoscopy surgery decortication may be suggested to be a method other than tube thoracostomy to deal with fibrinopurulent stage of parapneumonic empyema patients with coronary artery disease and reduced left ventricular ejection fraction.
Collapse
Affiliation(s)
- Chen-Hao Hsiao
- Department of Surgery, Cheng Hsin General Hospital, Taipei, Taiwan
- Genome and Systems Biology Degree Program, National Taiwan University and Academia Sinica, Taipei, Taiwan
| | - Ke-Cheng Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung Shan S. Rd, Taipei, 10002, Taiwan
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung Shan S. Rd, Taipei, 10002, Taiwan.
- Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan.
- Division of Experimental Surgery, National Taiwan University Hospital, Taipei, Taiwan.
| |
Collapse
|
22
|
Tacconi F, Pompeo E. Non-intubated video-assisted thoracic surgery: where does evidence stand? J Thorac Dis 2016; 8:S364-75. [PMID: 27195134 DOI: 10.21037/jtd.2016.04.39] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In recent years, non-intubated video-assisted thoracic surgery (NIVATS) strategies are gaining popularity worldwide. The main goal of this surgical practice is to achieve an overall improvement of patients' management and outcome thanks to the avoidance of side-effects related to general anesthesia (GA) and one-lung ventilation. The spectrum of expected benefits is multifaceted and includes reduced postoperative morbidity, faster discharge, decreased hospital costs and a globally reduced perturbation of patients' well-being status. We have conducted a literature search to evaluate the available evidence on this topic. Meta-analysis of collected results was also done where appropriate. Despite some fragmentation of data and potential biases, the available data suggest that NIVATS operations can reduce operative morbidity and hospital stay when compared to equipollent procedures performed under GA. Larger, well designed prospective studies are thus warranted to assess the effectiveness of NIVATS as far as to investigate comprehensively the various outcomes. Multi-institutional and multidisciplinary cooperation will be welcome to establish uniform study protocols and to help address the questions that are to be answered yet.
Collapse
Affiliation(s)
- Federico Tacconi
- Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy
| | - Eugenio Pompeo
- Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy
| |
Collapse
|
23
|
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.
Collapse
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
| |
Collapse
|
24
|
Pompeo E. Minimally invasive thoracic surgery: new trends in Italy. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:269. [PMID: 26605315 DOI: 10.3978/j.issn.2305-5839.2015.10.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In Italy there exists quite a long and rich history in minimally invasive thoracic surgery. Pioneer Italian surgeons have been amongst those who first adopted video-assisted thoracic surgery (VATS) to perform procedures such as lobectomy and esophagectomy, respectively and quite many others have provided important contributions related to minimally invasive thoracic surgery and have proposed innovative ideas and creative technical refinements. According to a web search on recent studies published in Italy on minimally invasive thoracic surgery along the last 3 years, uniportal, nonintubated, and robotic VATS as well as VATS lobectomy have been found to represent the most frequently investigated issues. An ongoing active investigation in each of these sub-topics is contributing to a better definition of indications advantages and disadvantages of the various surgical strategies. In addition it is likely that combination strategies including adoption of uniportal and nonintubated approaches will lead to define novel ultra-minimally invasive treatment options.
Collapse
Affiliation(s)
- Eugenio Pompeo
- Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy
| |
Collapse
|
25
|
Pompeo E, Cristino B, Rogliani P, Dauri M. Urgent awake thoracoscopic treatment of retained haemothorax associated with respiratory failure. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:112. [PMID: 26046053 DOI: 10.3978/j.issn.2305-5839.2015.04.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 04/16/2015] [Indexed: 11/14/2022]
Abstract
A number of video-assisted thoracoscopic surgery (VATS) procedures are being increasingly performed by awake anesthesia in an attempt of minimizing the surgical- and anesthesia-related traumas. However, so far the usefulness of awake VATS for urgent management of retained haemothorax has been scarcely investigated. Herein we present two patients with retained haemothorax following previous thoracentesis and blunt chest trauma, respectively, who developed acute respiratory failure and underwent successful urgent awake VATS management under local anesthesia through a single trocar access.
Collapse
Affiliation(s)
- Eugenio Pompeo
- Departments of 1 Thoracic Surgery, 2 Pulmonology, 3 Anesthesia and Intensive Care, Policlinico Tor Vergata University, Rome, Italy
| | - Benedetto Cristino
- Departments of 1 Thoracic Surgery, 2 Pulmonology, 3 Anesthesia and Intensive Care, Policlinico Tor Vergata University, Rome, Italy
| | - Paola Rogliani
- Departments of 1 Thoracic Surgery, 2 Pulmonology, 3 Anesthesia and Intensive Care, Policlinico Tor Vergata University, Rome, Italy
| | - Mario Dauri
- Departments of 1 Thoracic Surgery, 2 Pulmonology, 3 Anesthesia and Intensive Care, Policlinico Tor Vergata University, Rome, Italy
| | | |
Collapse
|