Awake Thoracoscopic Biopsy of Interstitial Lung Disease

Pompeo, Eugenio; Rogliani, Paola; Cristino, Benedetto; Schillaci, Orazio; Novelli, Giuseppe; Saltini, Cesare

doi:10.1016/j.athoracsur.2012.10.043

Cited by 72 publications

(109 citation statements)

References 20 publications

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“…A pilot study from our institution included 30 patients who were offered NIVATS biopsy of interstitial lung disease (31). Eight (28%) patients had a diffusion-capacity for carbon monoxide (DLCO) <40% predicted although a DLCO <30% predicted constituted an absolute exclusion criteria.…”

Section: High-risk Patientsmentioning

confidence: 99%

Non-intubated video-assisted thoracic surgery: where does evidence stand?

Tacconi¹,

Pompeo²

2016

J. Thorac. Dis.

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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.Keywords: Non-intubated thoracic surgery; video-assisted thoracic surgery (VATS); awake VATS; regional more dangerous in patients with pre-existing pulmonary disease. Other well-known side-effects of GA and one-lung ventilation include-but are not limited to-induction of cardiac arrhythmias (16), transient hypoxemia, injury to liver and kidney, cognitive deterioration, and impairment in perioperative immunosurveillance (17). Mechanical airway injury secondary to double-lumen tube insertion should be also taken into account, even though the estimated incidence of airway laceration is extremely low (18).The rationale of NIVATS is that avoidance of one-lung ventilation may help achieve a reduction in perioperative morbidity, particularly in subjects with poor cardiorespiratory performance. Accordingly, it is not surprising that most of the earliest NIVATS experiences consisted of small caseseries dealing with management of patients with chronic respiratory failure or other comorbidity.A paradigm shift is-however-being observed more recently and in some centers, adoption of NIVATS is being progressively extended to patients without any substantial risk factor for GA and one-lung ventilation.Indeed, in a recent survey from the European Society of Thoracic Surgeons, 70% of responders believed that ideal candidates for NIVATS are patients with multiple comorbidities although it is worth noting that 20% of them affirmed to be also favorable to the use of NIVATS regardless of patients ' comorbidity profile (19). This strategy appears to be justified when taking into account benefits other than protection from postoperative complications, which include reduced hospital stay, better quality of recovery and lower procedure-related costs. Furthermore, a lesser perturbation of immune and endocrine s...

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Section: High-risk Patientsmentioning

confidence: 99%

Non-intubated video-assisted thoracic surgery: where does evidence stand?

Tacconi¹,

Pompeo²

2016

J. Thorac. Dis.

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“…In this decision, we were encouraged by the satisfactory results observed in other delicate subcohorts including patients undergoing awake lung volume reduction surgery for advanced emphysema, as well as patients with interstitial lung disease receiving MVATS biopsy (7,8).…”

Section: Discussionmentioning

confidence: 99%

“…In MVATS anesthetic management entailed maintenance of spontaneous ventilation and either a thoracic epidural catheter inserted at the T4-T5 level (6)(7)(8)(9)(10) or intercostal injection of lidocaine 2% plus ropivacaine 7.5% at the site(s) of surgical incision for thoracic analgesia. Physiologic patient monitoring included radial artery catheterization, bispectral index monitoring, and a capnograph stuck to a nostril for real-time end-tidal CO 2 assessment.…”

Section: Anesthesia and Surgical Techniquementioning

confidence: 99%

“…Taking into account this concept and on the basis of previous findings achieved by MVATS in other delicate patients subgroups (6)(7)(8), we have explored the applicability of this ultra-minimally invasive surgical strategy in patients with undetermined mediastinal tumors in order to assess feasibility, safety and results.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, other methodological and technological advances including uniportal surgical approaches and the use of small-sized instrumentation are being adopted in order to minimize the overall invasiveness of VATS thus defining novel minimalist surgical strategies (MVATS) (6)(7)(8)(9)(10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

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Minimalist video-assisted thoracic surgery biopsy of mediastinal tumors

et al. 2016

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Background: Mediastinal tumors often require surgical biopsy to achieve a precise and rapid diagnosis.However, subjects with mediastinal tumors may be unfit for general anesthesia, particularly when compression of major vessels or airways does occur. We tested the applicability in this setting of a minimalist (M) uniportal, video-assisted thoracic surgery (VATS) strategy carried out under locoregional anesthesia in awake patients (MVATS). Methods: We analyzed in a comparative fashion including propensity score matching, data from a prospectively collected database of patients who were offered surgical biopsy for mediastinal tumors through either MVATS or standard VATS. Tested outcome measures included feasibility, diagnostic yield, and morbidity. Results: A total of 24 procedures were performed through MVATS. Diagnostic yield was 100%. Median hospital stay and time interval to oncologic treatment were 2 days (IQR, 2-3 days) and 7 days (IQR, 5.5-11.5 days), respectively. At overall comparison (MVATS, N=24 vs. VATS, N=23), there was a significant difference in both frequency and severity of postoperative complication as measured by Clavien-Dindo classification (P<0.006). In a propensity score matched comparison (8 patients per group), grade 3 or 4 complications requiring aggressive management were found only in the general anesthesia group. Global time spent in the operating room was shorter in the MVATS group (P=0.05). Time interval to oncological treatment was the same between groups. Other differences were also found in SIRS score (P=0.05) and PaO 2 /FiO 2 (P=0.04) thus suggesting better adaption to perioperative stress. Conclusions: MVATS biopsy appears to be a reliable tool to optimize diagnostic assessment in patients with mediastinal tumors. It can offer high diagnostic accuracy due to large tissue samples, while reducing morbidity rate compared to the same operation under general anesthesia. More robust evaluation is needed to define the appropriateness of MVATS in this specific clinical setting.

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Assessment of Intercostal Nerve Block Analgesia for Thoracic Surgery

et al. 2021

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IMPORTANCEThe use of intercostal nerve block (ICNB) analgesia with local anesthesia is common in thoracic surgery. However, the benefits and safety of ICNB among adult patients undergoing surgery is unknown. OBJECTIVE To evaluate the analgesic benefits and safety of ICNB among adults undergoing thoracic surgery.DATA SOURCES A systematic search was performed in Ovid MEDLINE, Ovid Embase, Scopus, and the Cochrane Library databases using terms for ICNB and thoracic surgery (including thoracic surgery, thoracoscopy, thoracotomy, nerve block, intercostal nerves). The search and results were not limited by date, with the last search conducted on July 24, 2020.STUDY SELECTION Selected studies were experimental or observational and included adult patients undergoing cardiothoracic surgery in which ICNB was administered with local anesthesia via single injection, continuous infusion, or a combination of both techniques in at least 1 group of patients. For comparison with ICNB, studies that examined systemic analgesia and different forms of regional analgesia (such as thoracic epidural analgesia [TEA], paravertebral block [PVB], and other techniques) were included. These criteria were applied independently by 2 authors, and discrepancies were resolved by consensus. A total of 694 records were selected for screening. DATA EXTRACTION AND SYNTHESIS This study followed the Preferred Reporting Items forSystematic Reviews and Meta-analyses (PRISMA) reporting guideline. Data including patient characteristics, type of surgery, intervention analgesia, comparison analgesia, and primary and secondary outcomes were extracted independently by 3 authors. Synthesis was performed using a fixed-effects model. MAIN OUTCOMES AND MEASURESThe coprimary outcomes were postoperative pain intensity (measured as the worst static or dynamic pain using a validated 10-point scale, with 0 indicating no pain and 10 indicating severe pain) and opioid consumption (measured in morphine milligram equivalents [MMEs]) at prespecified intervals (0-6 hours, 7-24 hours, 25-48 hours, 49-72 hours, and >72 hours). Clinically relevant analgesia was defined as a 1-point or greater difference in pain intensity score at any interval. Secondary outcomes included 30-day postoperative complications and pulmonary function. RESULTSOf 694 records screened, 608 were excluded based on prespecified exclusion criteria.The remaining 86 full-text articles were assessed for eligibility, and 20 of those articles were excluded. All of the 66 remaining studies (5184 patients; mean [SD] age, 53.9 [10.2] years; approximately 59% men and 41% women) were included in the qualitative analysis, and 59 studies (continued)

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Awake Thoracoscopic Biopsy of Interstitial Lung Disease

Cited by 72 publications

References 20 publications

Non-intubated video-assisted thoracic surgery: where does evidence stand?

Non-intubated video-assisted thoracic surgery: where does evidence stand?

Minimalist video-assisted thoracic surgery biopsy of mediastinal tumors

Assessment of Intercostal Nerve Block Analgesia for Thoracic Surgery

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