Araştırma Makalesi
BibTex RIS Kaynak Göster

Awake video-assisted thoracoscopic surgery

Yıl 2021, Cilt: 31 Sayı: 3, 262 - 265, 20.09.2021
https://doi.org/10.54005/geneltip.996801

Öz

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.

Kaynakça

  • Hofmann HS. [VATS - technique and indications]. Chirurg. 2015;86(7):711-21.
  • Gonzalez-Rivas D, Bonome C, Fieira E, Aymerich H, Fernandez R, Delgado M, et al. Non-intubated video-assisted thoracoscopic lung resections: the future of thoracic surgery? Eur J Cardiothorac Surg. 2016;49(3):721–31.
  • Hsiao CH, Chen KC, Chen JS. Modified single-port non-intubated video-assisted thoracoscopic decortication in high-risk parapneumonic empyema patients. Surg Endosc. 2017;31(4):1719-27.
  • Pompeo E. Awake thoracic surgery--is it worth the trouble? Semin Thorac Cardiovasc Surg. 2012;24:106-14.
  • Bedetti B, Patrini D, Bertolaccini L, Crisci R, Solli P, Schmidt J, et al. Uniportal non-intubated thoracic surgery. J Vis Surg. 2018;4:18.
  • Mineo TC, Sellitri F, Fabbi E, Ambrogi V. Uniportal non-intubated lung metastasectomy. J Vis Surg. 2017;3:118.
  • Migliore M, Borrata F, Nardini M, Criscione A, Calvo D, Gangemi M, et al. Awake uniportal video-assisted thoracic surgery for complications after pneumonectomy. Future Oncol. 2016;12(23):51-4.
  • Cajozzo M, Lo Iacono G, Raffaele F, Anzalone AA, Fatica F, Geraci G, et al. Thoracoscopy in pleural effusion-two techniques: awake single-access video-assisted thoracic surgery versus 2-ports video-assisted thoracic surgery under general anesthesia. Future Oncol. 2015;11(24):39-41.
  • Metintas M. Medical Thoracoscopy at 105. Anniversary Eurasian J Pulmonol. 2015;17:129-35.
  • Doyle DJ, Goyal A, Bansal P, Garmon EH. American Society of Anesthesiologists Classification (ASA Class). StatPearls. Treasure Island (FL): StatPearls Publishing; 2020.
  • Karkhanis VS, Joshi JM. Pleural effusion: diagnosis, treatment, and management. Open Access Emerg Med. 2012;4:31-52.
  • Wang L, Liu D, Lu J, Zhang S, Yang X. The feasibility and advantage of uniportal video-assisted thoracoscopic surgery (VATS) in pulmonary lobectomy. BMC Cancer. 2017;17(1):75. 
  • Gonzalez-Rivas D, Fernandez R, de la Torre M, Rodriguez JL, Fontan L, Molina F. Single-port thoracoscopic lobectomy in a nonintubated patient: the least invasive procedure for major lung resection? Interact Cardiovasc Thorac Surg. 2014;19(4):552–5.
  • Congedo MT, Iezzi R, Nachira D, Larici AR, Chiappetta M, Calandriello L, et al. Uniportal VATS coil-assisted resections for GGOs. J Oncol. 2019;2019:5383086. 
  • 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.
  • Katlic MR. Video-Assisted Thoracic Surgery Utilizing Local Anesthesia and Sedation: How I Teach It. Ann Thorac Surg. 2017;104(3):727-30.
  • Kim YS, Park MJ, Rhim H, Lee MW, Lim HK. Sonographic analysis of the intercostal spaces for the application of high-intensity focused ultrasound therapy to the liver. AJR Am J Roentgenol. 2014;203(1):201-8.
  • Kolvenbach H, Lauven PM, Schneider B, Kunath U. Repetitive intercostal nerveblock via catheter for postoperative pain relief after thoracotomy. Thorac Cardiovasc Surg. 1989;37(5):273-6.
  • Kolettas A, Lazaridis G, Baka S, Mpoukovinas I, Karavasilis V, Kioumis I, et al. Postoperative pain management. J Thorac Dis. 2015;7:62-72.
  • Caviezel C, Schuepbach R, Grande B, Opitz I, Zalunardo M, Weder W, et al. Establishing a non-intubated thoracoscopic surgery programme for bilateral uniportal sympathectomy. Swiss Med Wkly. 2019;149:w20064.
  • Yuncu G, Atınkaya C, Türk F, Kıter G, Semerkant T. Thoracoscopy under local anesthesia for patients with a high cardiopulmonary risk index. Turk Gogus Kalp Dama. 2012;20:552-7.

Uyanık hastada video yardımlı torakoskopik cerrahi

Yıl 2021, Cilt: 31 Sayı: 3, 262 - 265, 20.09.2021
https://doi.org/10.54005/geneltip.996801

Öz

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.

Kaynakça

  • Hofmann HS. [VATS - technique and indications]. Chirurg. 2015;86(7):711-21.
  • Gonzalez-Rivas D, Bonome C, Fieira E, Aymerich H, Fernandez R, Delgado M, et al. Non-intubated video-assisted thoracoscopic lung resections: the future of thoracic surgery? Eur J Cardiothorac Surg. 2016;49(3):721–31.
  • Hsiao CH, Chen KC, Chen JS. Modified single-port non-intubated video-assisted thoracoscopic decortication in high-risk parapneumonic empyema patients. Surg Endosc. 2017;31(4):1719-27.
  • Pompeo E. Awake thoracic surgery--is it worth the trouble? Semin Thorac Cardiovasc Surg. 2012;24:106-14.
  • Bedetti B, Patrini D, Bertolaccini L, Crisci R, Solli P, Schmidt J, et al. Uniportal non-intubated thoracic surgery. J Vis Surg. 2018;4:18.
  • Mineo TC, Sellitri F, Fabbi E, Ambrogi V. Uniportal non-intubated lung metastasectomy. J Vis Surg. 2017;3:118.
  • Migliore M, Borrata F, Nardini M, Criscione A, Calvo D, Gangemi M, et al. Awake uniportal video-assisted thoracic surgery for complications after pneumonectomy. Future Oncol. 2016;12(23):51-4.
  • Cajozzo M, Lo Iacono G, Raffaele F, Anzalone AA, Fatica F, Geraci G, et al. Thoracoscopy in pleural effusion-two techniques: awake single-access video-assisted thoracic surgery versus 2-ports video-assisted thoracic surgery under general anesthesia. Future Oncol. 2015;11(24):39-41.
  • Metintas M. Medical Thoracoscopy at 105. Anniversary Eurasian J Pulmonol. 2015;17:129-35.
  • Doyle DJ, Goyal A, Bansal P, Garmon EH. American Society of Anesthesiologists Classification (ASA Class). StatPearls. Treasure Island (FL): StatPearls Publishing; 2020.
  • Karkhanis VS, Joshi JM. Pleural effusion: diagnosis, treatment, and management. Open Access Emerg Med. 2012;4:31-52.
  • Wang L, Liu D, Lu J, Zhang S, Yang X. The feasibility and advantage of uniportal video-assisted thoracoscopic surgery (VATS) in pulmonary lobectomy. BMC Cancer. 2017;17(1):75. 
  • Gonzalez-Rivas D, Fernandez R, de la Torre M, Rodriguez JL, Fontan L, Molina F. Single-port thoracoscopic lobectomy in a nonintubated patient: the least invasive procedure for major lung resection? Interact Cardiovasc Thorac Surg. 2014;19(4):552–5.
  • Congedo MT, Iezzi R, Nachira D, Larici AR, Chiappetta M, Calandriello L, et al. Uniportal VATS coil-assisted resections for GGOs. J Oncol. 2019;2019:5383086. 
  • 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.
  • Katlic MR. Video-Assisted Thoracic Surgery Utilizing Local Anesthesia and Sedation: How I Teach It. Ann Thorac Surg. 2017;104(3):727-30.
  • Kim YS, Park MJ, Rhim H, Lee MW, Lim HK. Sonographic analysis of the intercostal spaces for the application of high-intensity focused ultrasound therapy to the liver. AJR Am J Roentgenol. 2014;203(1):201-8.
  • Kolvenbach H, Lauven PM, Schneider B, Kunath U. Repetitive intercostal nerveblock via catheter for postoperative pain relief after thoracotomy. Thorac Cardiovasc Surg. 1989;37(5):273-6.
  • Kolettas A, Lazaridis G, Baka S, Mpoukovinas I, Karavasilis V, Kioumis I, et al. Postoperative pain management. J Thorac Dis. 2015;7:62-72.
  • Caviezel C, Schuepbach R, Grande B, Opitz I, Zalunardo M, Weder W, et al. Establishing a non-intubated thoracoscopic surgery programme for bilateral uniportal sympathectomy. Swiss Med Wkly. 2019;149:w20064.
  • Yuncu G, Atınkaya C, Türk F, Kıter G, Semerkant T. Thoracoscopy under local anesthesia for patients with a high cardiopulmonary risk index. Turk Gogus Kalp Dama. 2012;20:552-7.
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Original Article
Yazarlar

Hüseyin Yıldıran

Güven Sadi Sunam Bu kişi benim

Yayımlanma Tarihi 20 Eylül 2021
Gönderilme Tarihi 5 Ekim 2020
Yayımlandığı Sayı Yıl 2021 Cilt: 31 Sayı: 3

Kaynak Göster

Vancouver Yıldıran H, Sunam GS. Uyanık hastada video yardımlı torakoskopik cerrahi. Genel Tıp Derg. 2021;31(3):262-5.