Non-intubated single surgeon single-port video-assisted thoracic surgery: A retrospective evaluation of the first experiences in a secondary care hospital

Abstract

Aim: Performing thoracic surgical procedures in a secondary care hospital is often challenging due to shortness of staff and lack of technical opportunities. Non-intubated thoracic surgery can be performed in patients with high risk for general anesthesia. Our aim is to share our non-intubated video-thoracoscopic surgery experience in such a public hospital. Methods: We have performed 10 non-intubated video-thoracoscopic surgery between March 2022 and November 2023. Seven patients were male. Single thoracic surgeon performed all the operations. Patients were analyzed in terms of characteristics, diagnosis, procedure type, operative time, analgesic methods, pain score, complications and follow-up data. Results: Mean age was 62 (29-90). Six patients underwent pleural drainage, deloculation and talk insufflation performed in two patients. Pleural biopsy was performed in one patient. Five patients were operated on due to insufficient drainage of coagulum and poor lung expansion after chest tube insertion for hemothorax. No patients required intubation. Operative mortality wasn’t seen. Eight patients received erector spinae plane block. The mean operation duration was 41 minutes. No operation related complication was observed. Average Visual Analogue Scale in 24 hours was 0-1 The mean length of hospital stay was 5 (2-10) days. Conclusion: Carefully planned thoracic surgeries for pleural pathologies can be performed with a non-intubated video-thoracoscopic approach safely. Respiratory management during surgery and perioperative management of pain is crucial to achieve best results with low operative risk. Authors suggest that the surgeon and anesthesiologist must be trained in a high volume thoracic surgery center.

Keywords

• awake
• non-intıbated
• VATS
• thoracic surgery
• single surgeon
• single port

Entübe olmayan tek cerrahlı ve tek portlu video yardımlı torasik cerrahi: İkinci basamak bir hastane ilk deneyimlerinin retrospektif değerlendirmesi

Abstract

References

1. 1. Szabo Z, Fabo C, Szarvas M, et al. Spontaneous Ventilation Combined with Double-Lumen Tube Intubation during Thoracic Surgery: A New Anesthesiologic Method Based on 141 Ca-ses over Three Years. J Clin Med Res. 2023;12(20):6457.
2. 2. Xue W, Duan G, Zhang X, et al. 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. 3. Turna A, Özçıbık Işık G, Ekinci Fidan M, et al. Can postoperative complications be reduced by the application of ERAS protocols in operated non-small cell lung cancer patients? Turk Gogus Kalp Damar Cerrahisi Derg. 2023;31:256–268.
3. 4. Grott M, Eichhorn M, Eichhorn F, et al. Thoracic surgery in the non-intubated spontaneously breathing patient. Respir Res. 2022;23:379.
4. 5. Liu Z, Yang R, Sun Y. Non-intubated subxiphoid uniportal video-assisted thoracoscopic thymectomy. Interact Cardiovasc Thorac Surg. 2019;29:742–745.
5. 6. Liu J, Cui F, Li S, et al. Nonintubated video-assisted thoracoscopic surgery under epidural anesthesia compared with conventional anesthetic option: a randomized control study. Surg Innov. 2015;22:123–130.
6. 7. Anile M, Vannucci J, Ferrante F, et al. Non-Intubated Thoracic Surgery: Standpoints and Perspectives. Front Surg. 2022;9:937633.