Awake video-assisted pleural decortication for empyema thoracis☆

Tacconi, Federico; Pompeo, Eugenio; Fabbi, Eleonora; Mineo, Tommaso Claudio

doi:10.1016/j.ejcts.2009.08.003

Cited by 78 publications

(53 citation statements)

References 22 publications

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“…Similar results came from Cajozzo et al (27). Finally in a controlled study from Tacconi et al (40), no substantial difference in morbidity rate was found with either NIVATS or GAVATS decortication for stage II pleural empyemas.…”

Section: High-risk Patientssupporting

confidence: 71%

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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 Patientssupporting

confidence: 71%

“…Other non-randomized studies reported significant differences in hospital stay in the settings of pleural effusion (27,40), pulmonary metastasectomy (42) and secondary PNX (36). On contrary, Wu et al (33) in their study on NIVATS lobectomy in a geriatric population failed to demonstrate any difference in hospital stay length (33).…”

Section: Hospital Staymentioning

confidence: 94%

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

Tacconi¹,

Pompeo²

2016

J. Thorac. Dis.

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“…During more than a decade this program achieved a consistent amount of knowledge about the surgery in awake patients and produced a great number of scientific publications (68,69,81,84,(95)(96)(97)(98)(99)(100)(101)(102)(103)(104)(105). In our program we initially privileged anesthesia delivered through an epidural catheter with a fully awake and collaborative patient (96)(97)(98)(99). In this way we achieved the neurological surveillance that we consider a physiological pattern of monitoring.…”

Section: The Awake Anesthesia In Progressmentioning

confidence: 99%

A glance at the history of uniportal video-assisted thoracic surgery

Mineo¹,

Ambrogi²

2017

J. Vis. Surg.

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In the history of thoracic surgery, the advent of video-assisted thoracic surgery (VATS) had on effect equivalent to that provoked by a true revolution. VATS successfully allowed minor, major and complex procedures for various lung and mediastinal pathologies with small incision instead of the traditional accesses. These small incisions abolished ugly scars, generated less acute and chronic pain, reduced hospital stay and costs, allowed faster return to normal day life activities. Conventional VATS was initially performed

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“…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%

“…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%

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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Awake video-assisted pleural decortication for empyema thoracis☆

Cited by 78 publications

References 22 publications

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

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

A glance at the history of uniportal video-assisted thoracic surgery

Minimalist video-assisted thoracic surgery biopsy of mediastinal tumors

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