Awake video-assisted thoracoscopic surgery

Year 2021, Volume: 31 Issue: 3, 262 - 265, 20.09.2021

Hüseyin Yıldıran Güven Sadi Sunam

https://doi.org/10.54005/geneltip.996801

Abstract

Objective: Non-intubated video-assisted thoracoscopic surgery (NI-VATS) with sedoanalgesia is commonly used and became an increasingly popular surgical technique for minimal invasive procedures in the last decade. In this study it is aimed to present the usage of the awake video-assisted thoracic surgery (A-VATS) technique with pure local anesthesia without sedation or thoracic epidural anesthesia.

Material and Methods: Between 2009 and 2019, 43 patients who underwent awake video-assisted thoracoscopic surgery were evaluated retrospectively. Patients who classified as high risk for general anesthetic were included in the study. In this VATS technique, after the skin preparation, 10 ml 0.5% bupivacaine with 10 ml saline was administered subcutaneously and intramuscularly. 15 minutes later, a single port incision was made to the thorax for 10-mm 0-degree single-puncture videothoracoscope.

Age, sex, complaints, laterality, type of effusion, cytology results, comorbidities of patients, length of hospital stay, amount of drained effusion, operation time, and pathology results were evaluated retrospectively.

Results: Forty-three patients (23 male, 20 female) were evaluated. The mean age was 67.32 (45–85) years. The dominant complaint (n = 40) was dyspnea. A-VATS was performed on 22 left and 21 right sides. There was 39 patients with hydrothorax, 4 with pneumothorax. The mean total fluid discharged by patients with hydrothorax was 1311 ml (400–4000 ml). A-VATS wedge resection was performed for 2 patients because of pneumothorax due to bullae.

Conclusion: A-VATS is a safer technique in selected patients because it does not require muscle relaxants and sedatives.

Keywords

anesthesia, pleura, video-assisted thoracoscopic surgery

Uyanık hastada video yardımlı torakoskopik cerrahi

Abstract

Amaç: Sedoanaljezi eşliğinde entübasyon olmadan video yardımlı torakoskopik cerrahi (VATS) son on yılda minimal invaziv prosedürler için giderek daha popüler bir cerrahi teknik haline gelmiştir. Bu çalışmada ise, sedasyon veya torasik epidural anestezi kullanılamayan hastalarda sadece lokal anestezi ile uygulanan video yardımlı torakoskopi tekniğinin sunulması amaçlanmıştır.

Gereç ve Yöntemler: 2009-2019 yılları arasında, genel anestezi riski yüksek olarak sınıflandırılarak uyanık halde video yardımlı torakoskopik cerrahi yapılan 43 hasta retrospektif olarak incelendi.

10 ml izotonik ile sulandırılan 10 ml %0,5 bupivakain, cilt altına ve kas içine uygulandı. 15 dakika sonra 10 mm 0 derece videotorakoskop için toraksa tek bir port insizyonunu takiben VATS uygulandı.

Yaş, cinsiyet, başvuru yakınmaları, lateralite, efüzyon tipi, sitoloji sonuçları, hastaların komorbiditeleri, hastanede kalış süresi, efüzyon miktarı, ameliyat süresi ve patoloji sonuçları retrospektif olarak değerlendirildi.

Bulgular: Yaş ortalaması 67,32 (45-85) olan kırk üç hastanın 23’ü erkek, 20’si kadındı. En sık yakınma (n = 40) dispne idi. 22 sol ve 21 sağ hemitoraksa VATS uygulandı. 39 hidrotoraks, 4 pnömotoraks olgusu vardı. Hidrotoraks tanılı olgulardan drene edilen ortalama sıvı miktarı 1311 ml (400-4000 ml) idi. Bül nedeniyle pnömotoraks gelişen 2 olguya wedge rezeksiyon yapıldı. Hiçbir hastaya kas gevşetici veya sedasyon verilmedi.

Sonuç: Uyanık VATS seçilmiş hastalarda, kas gevşetici ve sedoanaljezi gerektirmediğinden güvenli bir tekniktir.

Keywords

anestezi, plevra, video-yardımlı torakoskopik cerrahi

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