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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.
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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
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First experiences in non-intubated, video-assisted thoracoscopic surgery: a single-centre study. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 18:15-22. [PMID: 34552639 PMCID: PMC8442089 DOI: 10.5114/kitp.2021.105181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/15/2021] [Indexed: 11/20/2022]
Abstract
Introduction Video-assisted thoracoscopic surgery (VATS) with non-intubated technique is safely performed under spontaneous breathing and sedation. With this surgery, many complex thoracic surgical interventions can be successfully applied. Aim We shared the results of our patients who underwent mediastinal biopsy, pleural biopsy, lung wedge resection, pneumothorax surgery, and pleural delocculation with non-intubated VATS. Material and methods Patients who underwent surgery with non-intubated VATS between March 2015 and May 2020 in our clinic were included in the study. The patients were evaluated in terms of many factors such as age, gender, applied surgical intervention, diagnosis, side of surgery, duration of surgery, and time of hospital stay, and the results were recorded retrospectively. Results Twenty of the patients were male and 12 were female. Regarding comorbid diseases in our patient group, 13 had extra-thoracic malignancy, 7 had hypertension, 6 had heart disease, 5 had chronic obstructive pulmonary disease and asthma, and 4 had diabetes mellitus. Pleural drainage and biopsy were performed in 10 patients and wedge resection in 8 patients. Bullectomy and apical pleural abrasion were performed in 6 patients, mediastinal mass biopsy was performed in 4 patients, and delocculation was performed in 4 patients due to empyema. Conclusions The non-intubated VATS approach can be safely applied in procedures such as lung resections, pleural or mediastinal interventions, and pneumothorax surgery. With this technique, the absence of intubation and mechanical ventilation facilitates the return to normal respiratory physiology, and we think that the recovery time of the patient, the duration of hospital stay, and treatment costs are reduced.
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Jung J, Kim DH, Son J, Lee SK, Son BS. Comparative study between local anesthesia and general anesthesia in the treatment of primary spontaneous pneumothorax. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:553. [PMID: 31807534 DOI: 10.21037/atm.2019.09.89] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background There is increasing interest in non-intubated video-assisted thoracoscopic surgery (VATS). At present, this method is used in various types of thoracic surgery. Especially, simple wedge resection via VATS is thought to be an optimal indication of non-intubated VATS. This study was performed to evaluate the usefulness of VATS bullectomy under local anesthesia by comparison with bullectomy under general anesthesia. Methods A total of 183 cases of wedge resection under general anesthesia and 52 cases of wedge resection under local anesthesia were examined. Medical records were retrospectively reviewed to assess the feasibility, usability, and cost effectiveness of wedge resection under local anesthesia. The preoperative clinical parameters, including age, sex, and the number of pneumothorax episodes and previous operations, were used to match cases and controls. Results There were no significant differences between the local and general anesthesia groups in operative time (57.5±23.1 and 56.6±25.6 min, respectively; P=0.857), type of operation [single-incision thoracoscopic surgery (SITS), n=48 and n=47, respectively; multi-port-VATS (M-VATS), n=4 and n=5, respectively; P=0.730], or chest tube indwelling time (3.6±1.5 and 4.4±2.5 days, respectively; P=0.064). The mean times from arrival at the operating room (OR) to skin incision (16.4±12.3 and 46.4±17.2 min, respectively; P<0.001), and from the end of surgery to arrival at the general ward (36.0±25.6 and 58.1±20.9 min, respectively; P<0.001) were significantly shorter in the local anesthesia group than the general anesthesia group. The total cost was significantly lower in the local anesthesia group than in the general anesthesia group (4,890.6±717.1 and 5,739.1±1,154.6, respectively; P<0.001). Conclusions Local anesthesia shortened the overall hospital stay by reducing the interval between admission and surgery, allowing immediate ambulation after surgery. In addition, this method reduced costs by avoiding the need for anesthesia.
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Affiliation(s)
- Joonho Jung
- Department of Thoracic and Cardiovascular Surgery, Ajou University Hospital, Suwon, Korea
| | - Do Hyung Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Medical Research Institute of Pusan National University, Busan, Korea
| | - Joohyung Son
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Medical Research Institute of Pusan National University, Busan, Korea
| | - Sung Kwang Lee
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Medical Research Institute of Pusan National University, Busan, Korea
| | - Bong Soo Son
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Medical Research Institute of Pusan National University, Busan, Korea
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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.
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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
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Okuda K, Moriyama S, Haneda H, Kawano O, Sakane T, Oda R, Watanabe T, Nakanishi R. Recent advances in video-assisted transthoracic tracheal resection followed by reconstruction under non-intubated anesthesia with spontaneous breathing. J Thorac Dis 2017; 9:2891-2894. [PMID: 29221259 DOI: 10.21037/jtd.2017.08.58] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Katsuhiro Okuda
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Satoru Moriyama
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Hiroshi Haneda
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Osamu Kawano
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Tadashi Sakane
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Risa Oda
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Takuya Watanabe
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Ryoichi Nakanishi
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
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Galvez C, Navarro-Martinez J, Bolufer S, Lirio F, Sesma J, Corcoles JM. Nonintubated uniportal VATS pulmonary anatomical resections. J Vis Surg 2017; 3:120. [PMID: 29078680 DOI: 10.21037/jovs.2017.08.10] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/09/2017] [Indexed: 11/06/2022]
Abstract
Nonintubated procedures have widely developed during the last years, thus nowadays major anatomical resections are performed in spontaneously breathing patients in some centers. In an attempt for combining less invasive surgical approaches with less aggressive anesthesia, nonintubated uniportal video-assisted thoracic surgery (VATS) lobectomies and segmentectomies have been proved feasible and safe, but there are no comparative trials and the evidence is still poor. A program in nonintubated uniportal major surgery should be started in highly experienced units, overcoming first a learning period performing minor procedures and a training program for the management of potential crisis situations when operating on these patients. A multidisciplinary approach including all the professionals in the operating room (OR), emergency protocols and a comprehensive knowledge of the special physiology of nonintubated surgery are mandatory. Some concerns about regional analgesia, vagal block for cough reflex control and oxygenation techniques, combined with some specific surgical tips can make safer these procedures. Specialists must remember an essential global concept: all the efforts are aimed at decreasing the invasiveness of the whole procedure in order to benefit patients' intraoperative status and postoperative recovery.
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Affiliation(s)
- Carlos Galvez
- Department of Thoracic Surgery, University General Hospital, Alicante, Spain
| | - Jose Navarro-Martinez
- Department of Anesthesiology and Surgical Critical Care, University General Hospital, Alicante, Spain
| | - Sergio Bolufer
- Department of Thoracic Surgery, University General Hospital, Alicante, Spain
| | - Francisco Lirio
- Department of Thoracic Surgery, University General Hospital, Alicante, Spain
| | - Julio Sesma
- Department of Thoracic Surgery, University General Hospital, Alicante, Spain
| | - Juan Manuel Corcoles
- Department of Thoracic Surgery, University Hospital of Vinalopo, Alicante, Spain
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Alqatari A, Eldawlatly A. Anesthesia for video-assisted thoracic surgery: An algorithm. Saudi J Anaesth 2017; 11:265-266. [PMID: 28757823 PMCID: PMC5516485 DOI: 10.4103/sja.sja_282_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Ahmad Alqatari
- Department of Anesthesia, College of Medicine, King Saud University, Riyadh, Saudi Arabia. E-mail:
| | - Abdelazeem Eldawlatly
- Department of Anesthesia, College of Medicine, King Saud University, Riyadh, Saudi Arabia. E-mail:
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Wang ML, Galvez C, Chen JS, Navarro-Martinez J, Bolufer S, Hung MH, Hsu HH, Cheng YJ. Non-intubated single-incision video-assisted thoracic surgery: a two-center cohort of 188 patients. J Thorac Dis 2017; 9:2587-2598. [PMID: 28932566 DOI: 10.21037/jtd.2017.08.96] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Non-intubated single-incision procedures are slowly expanding because of high experience and skill required, and stricter selection criteria. The aim of this study is to present the first retrospective two-center series in Taiwan and Spain. METHODS We performed a retrospective analysis of 188 patients undergoing non-intubated single-incision video-assisted thoracic surgery (NI-SI-VATS) procedures between July 2013 to November 2015 in two centers in Taiwan (170 patients) and Spain (18 patients) with two different anesthetic methods. Demographic data, clinicopathological features, preoperative tests, and final outcomes were analyzed to compare the outcomes with the two different techniques. RESULTS Of the 188 patients, 147 (78%) were women, with a mean body mass index (BMI) of 22.7. Of the 196 specimens, 145 (74%) were malignancies with a mean size of 9.7 mm. Wedge resection was performed in 172 patients (91.4%), anatomical segmentectomy with lymphadenectomy in 8 (4.7%), and lobectomy with lymphadenectomy in 5 (2.6%). Three patients (1.6%) required conversion to orotracheal intubation, while 5 patients (2.7%) required additional ports. Complications appeared in 16 patients (8.5%) with air leak as the most frequent in 7 cases (3.7%). Median chest drainage was 1 day, and median postoperative stay was 3 days. There was neither perioperative death nor postoperative readmission. CONCLUSIONS Non-intubated single-incision procedures can be feasible and safe in expert hands and experienced teams, even for anatomical resections. Strict selection criteria, skill and experience are mandatory. Comparative cohorts and randomized trials are needed.
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Affiliation(s)
- Man-Ling Wang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Carlos Galvez
- Department of Thoracic Surgery, University General Hospital of Alicante, Alicante, Spain
| | - Jin-Shing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University, Taipei, Taiwan
| | - Jose Navarro-Martinez
- Department of Anesthesiology and Surgical Critical Care Department, University General Hospital of Alicante, Alicante, Spain
| | - Sergio Bolufer
- Department of Thoracic Surgery, University General Hospital of Alicante, Alicante, Spain
| | - Ming-Hui Hung
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsao-Hsung Hsu
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University, Taipei, Taiwan
| | - Ya-Jung Cheng
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
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Abstract
Surgical treatment for lung cancer including airway resection following reconstruction is typically performed under general anesthesia with single-lung ventilation because it is necessary to maintain a sufficient working space and to adjust the airway pressure for the leak test. However, non-intubated thoracic surgery has been gradually developed in recent years for thoracoscopic surgery, due to its lower rate of postoperative complications, shorter hospitalization duration, and lower invasiveness than the usual single-lung anesthesia. Initially, only minor thoracoscopic surgery, including wedge resection for pneumothorax and the diagnosis of solitary pulmonary nodules, was performed under waking anesthesia. However, major thoracoscopic surgery, including segmentectomy and lobectomy, has also been performed under these conditions in some institutions due to its advantages with respect to the postoperative recovery and in-operating room time. In addition, non-intubated thoracic surgery has been performed for tracheal resection followed by reconstruction to fully explore the advantages of this surgical modality. In this article, the merits and demerits of non-intubated thoracoscopic surgery and the postoperative complications, perioperative problems and optimum selection criteria for patients for thoracic surgery (mainly airway surgery) are discussed.
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Affiliation(s)
- Katsuhiro Okuda
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Ryoichi Nakanishi
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
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Dai X, Song P, Zhang B. [Application of Non-intubated Anesthesia in VATS]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:312-6. [PMID: 27215461 PMCID: PMC5973052 DOI: 10.3779/j.issn.1009-3419.2016.05.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
气管插管全麻技术可提高手术安全性,因此在电视胸腔镜手术(video-assisted thoracic surgery, VATS)中得到广泛应用,但气管插管的并发症却无法避免。如何发展一种“整体微创”手术(包括麻醉微损伤),已经成为微创胸外科领域的一个研究热点。随着麻醉管理技术与对手术风险管理的进步,非气管插管技术成功应用于VATS,即采用局部麻醉以维持患者的术中自主通气,术中仅需轻微镇静或者完全清醒的状态下实施VATS,因而又称清醒状态下VATS。此麻醉方式不但减少气管插管的麻醉损伤,而且符合快速康复外科的理念。本文对非气管插管应用在胸外科VATS中的发展简史、麻醉选择、手术优势、手术风险及管理、面临的问题等方面作一综述。
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Affiliation(s)
- Xiaotan Dai
- School of Medicine and Life Sclences, University of Jinan, Jinan 250117, China
| | - Pingping Song
- School of Medicine and Life Sclences, University of Jinan, Jinan 250117, China
| | - Baijiang Zhang
- Shandong Academy of Medical Sciences, Jinan 250117, China
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