Non-intubated thoracoscopic surgery: initial experience at a single center

Moon, Youngkyu; AlGhamdi, Zeead M; Jeon, Joonpyo; Hwang, Wonjung; Kim, Yun‐Ho; Sung, Sook Whan

doi:10.21037/jtd.2018.05.147

Cited by 21 publications

(19 citation statements)

References 17 publications

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“…The anesthesia and operative times were similar in our patient groups. We initiated non-intubated VATS after August 2016 to reduce the risk of complications of intubation [12,13], and this corresponded closely to the January 2017 introduction of uniportal VATS at our institution. As such, the rate of non-intubated anesthesia was significantly higher in the uniportal group, which is a potential source of bias.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Uniportal versus Multiportal Video-Assisted Thoracoscopic Surgery Pulmonary Segmentectomy

Lee

Choi

et al. 2019

Korean J Thorac Cardiovasc Surg

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Background Uniportal video-assisted thoracoscopic surgery (VATS) has proven safe and effective for pulmonary wedge resection and lobectomy. The objective of this study was to evaluate the safety and feasibility of uniportal VATS segmentectomy by comparing its outcomes with those of the multiportal approach at a single center. Methods The records of 84 patients who underwent VATS segmentectomy from August 2010 to August 2018, including 33 in the uniportal group and 51 in the multiportal group, were retrospectively reviewed and analyzed. Results Anesthesia and operative times were similar in the uniportal and multiportal groups (215 minutes vs. 220 minutes, respectively; p=0.276 and 180 minutes vs. 198 minutes, respectively; p=0.396). Blood loss was significantly lower in the uniportal group (50 mL vs. 100 mL, p=0.013) and chest tube duration and hospital stay were significantly shorter in the uniportal group (2 days vs. 3 days, p=0.003 and 4 days [range, 1–14 days] vs. 4 days [range, 1–62 days], p=0.011). The number of dissected lymph nodes tended to be lower in the uniportal group (5 vs. 8, p=0.056). Conclusion Our preliminary experience indicates that uniportal VATS segmentectomy is safe and feasible in well-selected patients. A randomized, prospective study with a large group of patients and long-term follow-up is necessary to confirm these results.

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Section: Discussionmentioning

confidence: 99%

Comparison of Uniportal versus Multiportal Video-Assisted Thoracoscopic Surgery Pulmonary Segmentectomy

Lee

Choi

et al. 2019

Korean J Thorac Cardiovasc Surg

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“…These findings were exactly in accordance with previous studies. 11,12 June Lee and colleagues, 13 however, noticed that patients with Multi-portal VATS had more blood loss. The possible justification of this difference could be the judicious and cautious use of diathermy in port site creation in our study that resulted in minimal blood loss.…”

Section: Discussionmentioning

confidence: 99%

Transition from Multi-portal to Uni-portal Video Assisted Thoracoscopic Surgery: A Modern Era Requirement

Tarar

Nadeem

Khan

et al. 2020

APMC

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“…The conversion rate from NITS into an intubated surgery is between 2 and 11% (21)(22)(23)(24)(25)(26), differing based on centers and countries but primarily by learning time. NITS experience may be a key point affecting the conversion rate.…”

Section: Non-intubated To Intubated Conversion Ratementioning

confidence: 99%

Converting to Intubation During Non-intubated Thoracic Surgery: Incidence, Indication, Technique, and Prevention

Chiang

Lin

2021

Front. Surg.

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Traditionally, intubated general anesthesia with one-lung ventilation is standard in thoracoscopic surgery. However, in recent decades, non-intubated thoracoscopic surgery (NITS) has become an alternative method to minimize the adverse effects of intubated general anesthesia. Non-intubated procedures result in fewer adverse events than tracheal intubation and general anesthesia, such as intubation-related airway injury, ventilation-induced lung injury, prolonged hospital stay, and postoperative nausea and vomiting. Despite these benefits, surgeons must consider the possibility of converting to intubation during NITS as the conversion rate is between 2 and 11%, varying between regions and learning time. The conversion rate is also affected by race, body size, the learning curve, and the surgical team's preferred methods. There are surgical (e.g., significant respiratory movements, uncontrolled bleeding, hindered surgical fields, large tumor sizes, adhesions) and anesthetic (e.g., hypoxemia, hypercapnia, airway spasms) reasons for converting to intubation. When a conversion is deemed necessary by the surgical team, the members should be well-prepared and act rapidly. Anesthesiologists should also feel comfortable intubating patients in the lateral decubitus position with or without bronchoscopic guidance. Patient selection is the key factor for avoiding conversion into an intubated surgery. Patients with an American Society of Anesthesiologists grade 2 or less, a body mass index <25, and less surgical complexity may be good candidates for NITS. Careful monitoring, adequate anesthesia depth, an experienced surgical team, and sufficient preparation can also prevent conversion. Conversion from a non-intubated into intubated thoracic surgery is unwanted but not inevitable. Therefore, NITS can be successful when performed on select patients by a well-prepared and experienced surgical team and is worthy of recommendation owing to its non-invasiveness.

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Non-intubated thoracoscopic surgery: initial experience at a single center

Abstract: Non-intubated thoracoscopic surgery can safely be performed in selected patients.

Cited by 21 publications

References 17 publications

Comparison of Uniportal versus Multiportal Video-Assisted Thoracoscopic Surgery Pulmonary Segmentectomy

Comparison of Uniportal versus Multiportal Video-Assisted Thoracoscopic Surgery Pulmonary Segmentectomy

Transition from Multi-portal to Uni-portal Video Assisted Thoracoscopic Surgery: A Modern Era Requirement

Converting to Intubation During Non-intubated Thoracic Surgery: Incidence, Indication, Technique, and Prevention

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