Perioperative outcomes of non-intubated versus intubated video-assisted thoracoscopic surgery in different thoracic procedures: a propensity score-matched analysis

Abstract

Background Non-intubated video-assisted thoracoscopic surgery (NIVATS) is increasingly performed in different types of thoracic procedures. Based on the anesthetic perspective, the outcomes of this method are limited. General anesthesia with intubation and controlled ventilation for video-assisted thoracoscopic surgery (IVATS) is a standard technique. The current study aimed to compare the pulmonary gas exchange between NIVATS and IVATS, with a focus on desaturation event. Methods This was a retrospective study conducted at Vajira Hospital. Data were collected from the hospital medical record database between January 9, 2019, and May 15, 2020. A propensity score-matched analysis was used to adjust the confounders by indications and contraindication between NIVATS and IVATS. The perioperative outcomes of VATS and NIVATS were compared by the regression analysis method. Results In total, 180 patients were included in the analysis. There were 98 and 82 patients in the NIVATS and IVATS groups, respectively. After a propensity score matching, the number of patients with similar characteristics decreased to 52 per group. None of the patients in both groups experienced desaturation. The lowest oxygen saturation of the NIVATS and IVATS groups did not significantly differ (96.5% vs. 99%, respectively; p = 0.185). The NIVATS group had a significantly higher ETCO2 peak than the IVATS group (43 vs. 36 mmHg, respectively; p < 0.001). According to the regression analysis, the NIVATS group had a significantly shorter anesthetic induction time (Mean difference (MD) = -5.135 min (95% CI = (- 8.878)- (-1.391)) and lower volume of blood loss (MD = -75.565 ml (95%CI = (- 131.08)—(- 20.65) but a higher intraoperative ETCO2 than the IVATS group (MD = 4.561 mmHg (95%CI = 1.852—7.269). Four patients in the NIVATS group required conversion to intubation due to difficulties encountered when using the surgical technique (7.7%, p = 0.041). Seven patients in the IVATS group, but none in the NIVATS group, presented with sore throat (13.5% vs. 0%, respectively; p = 0.006). Moreover, none of the patients in both groups experienced postoperative pneumonia, underwent reoperation, or died. Conclusions The anesthetic and surgical outcomes of NIVATS were comparable to those of IVATS.

Awake uniportal video-assisted thoracoscopic surgery for the management of pericardial effusion

“…BMI ≥30 is considered a contraindication for non-intubated VATS. [ 20 , 25 ] In our study, the mean BMI was 29.1 ± 6,0 kg/m 2 ; nine of our patients were overweight (BMI ≥25–30), three were obese (BMI ≥30–35) and three were morbidly obese (BMI ≥35); we had no difficulty in reaching the thoracic cavity during the procedure.…”

“…However, general anaesthesia with endobronchial intubation and single-lung positive pressure ventilation have always been considered mandatory to provide safe and optimal working conditions and surgical manipulation in thoracic surgery. [ 19 , 20 ]…”

Outcomes of Non-intubated Versus Intubated Thoracoscopic Surgery for Primary Spontaneous Pneumothorax

“…The PSP patient group generally consists of young, thin patients with adequate respiratory reserves and no additional comorbidities. In addition, intraoperative artificial pneumothorax, which causes sufficient lung collapse, provides an opportunity for surgical maneuvers because the bullae and blebs in the apical segment of the lung are resected away from the diaphragm, which continues to contract 12,13 . Based on our experience, surgical exposure is difficult in N-VATS for other lesions close to the diaphragm, and patients can easily develop hyperpnea.…”

“…In addition, intraoperative artificial pneumothorax, which causes sufficient lung collapse, provides an opportunity for surgical maneuvers because the bullae and blebs in the apical segment of the lung are resected away from the diaphragm, which continues to contract. 12,13 Based on our experience, surgical exposure is difficult in N-VATS for other lesions close to the diaphragm, and patients can easily develop hyperpnea. Therefore, N-VATS can be considered contraindicated for lesions located in or adjacent to the diaphragm.…”

Current overview of awake, non-intubated, video-assisted thoracic surgery.

“…This resulted in questioning other alternatives and methods of protection from anaesthesia risks [9]. First, VATS applications were performed with sedation and local anaesthesia in pleural effusion and pneumothorax, and later in thoracic sympathectomy applications, thus avoiding the risks of laryngotracheal injury Current overview of awake, non-intubated, video-assisted thoracic surgery of both general anaesthesia and double-lumen intubation, which is generally preferred in VATS [10].…”