Is there a benefit of awake thoracoscopic surgery in patients with secondary spontaneous pneumothorax?

Noda, Masafumi; Okada, Yoshinori; Maeda, Shin; Sado, Tetsu; Sakurada, Akira; Hoshikawa, Yasushi; Endo, Chiaki; Kondo, Takashi

doi:10.1016/j.jtcvs.2011.07.067

Cited by 52 publications

(41 citation statements)

References 12 publications

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“…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: 95%

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: Hospital Staymentioning

confidence: 95%

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

Tacconi¹,

Pompeo²

2016

J. Thorac. Dis.

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“…Published data demonstrates that non-intubated techniques offer quicker recovery times, better pain scores, lower morbidity rates and shorter hospital length of stays compared with intubated surgery (6)(7)(8)(9)(10)(11)(12)(13)(14)(15) and there may also be an attenuation of stress hormone and immunologic responses (15,20,21). Awake and minimal sedation techniques also avoid the need for general anaesthesia, thus maintaining a more physiological cardiopulmonary and neurological status and avoiding post-operative nausea and vomiting.…”

Section: Potential Advantagesmentioning

confidence: 99%

“…Initial published reports on non-intubated surgery utilised thoracic epidural anaesthesia for three-port conventional VATS performed awake or under minimal sedation (6)(7)(8)(9)(10)(11)15,32,39,40). However, for simpler procedures or single port VAT surgery, epidural anaesthesia is now not deemed necessary and intercostal nerve blocks and paravertebral block are becoming more popular with the use of targeted sedation (24,25,30,31,33,34,40).…”

Section: Other Techniquesmentioning

confidence: 99%

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Anaesthetic considerations for non-intubated thoracic surgery

Irons¹,

Martínez²

2016

J. Vis. Surg.

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General anaesthesia with intubation and single lung ventilation has always been considered essential for thoracic surgery. Over the last decade there has been a huge evolution in thoracic surgery with the development of multiport and uniportal minimally invasive techniques. The development of a non-intubated technique during which thoracic surgery is performed on patients who are spontaneously ventilating awake, under minimal sedation with the aid of local or regional anaesthesia or under general anaesthesia with a supraglottic airway device is winning acceptance as a valid alternative technique. The concept is to allow the creation of a spontaneous pneumothorax as the surgeon enters the chest. This can provide excellent lung isolation without the need for positive pressure ventilation on the dependant lung.Awake and minimal sedation techniques, which avoid the need for general anaesthesia, maintain a more physiological cardiopulmonary and neurological status and avoid postoperative nausea and vomiting.However, general anaesthesia with a supraglottic airway device is the technique that provides a more stable airway and facilitates oxygenation in cases where an unexpected conversion to open thoracotomy in needed.For non-intubated thoracic surgery a regional analgesic technique is essential; nonetheless a 'multimodal' approach to analgesia is recommended. Non-intubated anaesthetic techniques for thoracic surgery are innovative and exciting and drive to reduce the invasiveness of the procedures. We recommend that centres starting out with non-intubated techniques begin by performing minor video-assisted thoracic surgery (VATS) procedures in selected low risk patients. Early elective conversion should be employed in any unexpected surgical difficulty or cardiopulmonary problem during the learning curve to reduce the risk of emergency conversion and complications. Further research is needed to establish which patients benefit more from the technique and what is the real impact on perioperative mortality and morbidity.

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“…Pompeo and the Awake Thoracic Surgery Research Group [21] have shown that an intraoperative drop in the ratio of the arterial oxygen tension to the fraction of inspired oxygen may occur both in patients with normal lung and in patients with severe obstructive pulmonary disease; in the latter, it is caused by a reduction in intrinsic positive end-expiratory pressure in the peripheral alveolar region. These findings also suggest that positioning patients in the lateral decubitus position during the procedure rather than in the supine position might be preferred to reduce the perfusion of the nondependent lung and consequently the shunt fraction [21,22]. The results reported by Grendelmeier et al [15] highlight important messages.…”

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confidence: 99%