Anesthesia and enhanced recovery in subxiphoid video-assisted thoracoscopic surgery

Chen, Zhigang; Ali, Jason M.; Xu, Huan; Jiang, Lei; Aresu, Giuseppe

doi:10.21037/jtd.2018.11.90

Cited by 3 publications

(12 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Having a full understanding of using a 30° operating telescope is essential to achieve the visualization necessary for SVATS procedures. It is important for the assistant to withdraw the camera each time a new instrument is introduced into the surgical field to ensure this is performed under vision to avoid inadvertent injury-especially to the heart in left sided procedures (7).…”

Section: Review Articlementioning

confidence: 99%

“…Preoperative discussion should be held by the surgical team to select patients most suitable for the SVATS approach. It is advisable to follow the following inclusion and exclusion criteria that could be loosened after gaining experience and with progression of learning curve (6,7,9).…”

Section: Case Selectionmentioning

confidence: 99%

“…The instruments with their specific angles have helped in reducing instrument interference, reducing cardiac compression, whilst providing easier and more comfortable exposure, dissection and cauterization of tissues. Also, use of curved tip staplers facilitates easier division of different structures during the procedure (4,6,7,9,11). A thoracoscope which can provide a variable range of view could also help to examine the posterior aspect of the lung for posterior mediastinal lesions and lymph node (3).…”

Section: Instrumentsmentioning

confidence: 99%

“…There are now reports describing use of SVATS across a wide range of thoracic surgical procedures including thymectomy, metastasectomy, pneumothorax surgery and anatomical lung resections including lobectomy and segmentectomy (1)(2)(3)(4). With experience and passing through the learning curve there have been modifications made to the technique through the experience of many surgeons and development of new instruments (1,(4)(5)(6)(7). This evolution has enabled SVATS to become faster, easier and more feasible even in some previously challenging conditions (6,7).…”

Section: Introductionmentioning

confidence: 99%

“…With experience and passing through the learning curve there have been modifications made to the technique through the experience of many surgeons and development of new instruments (1,(4)(5)(6)(7). This evolution has enabled SVATS to become faster, easier and more feasible even in some previously challenging conditions (6,7).…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Tips and tricks for success in subxiphoid video-assisted thoracic surgery

et al. 2019

Self Cite

View full text Add to dashboard Cite

The subxiphoid approach to video-assisted thoracic surgery (VATS) has been introduced as an alternative to intercostal VATS. There is some evidence that avoiding intercostal incision and instrumentation leads to reduced pain and facilitates early mobilisation and enhanced recovery. Access of the pleural cavities and anterior mediastinal space through a subxiphoid incision presents some challenges, particularly when accessing posterior pulmonary lesions. With increasing experience, a large range of thoracic surgical operations performed through the subxiphoid approach have been reported including anatomical segmentectomies, thymectomies. Another attraction is that bilateral procedures can be performed through a single incision. The experience of several surgeons passing through the learning curve of subxiphoid VATS surgery has resulted in overcoming many of the early challenges faced. In this paper, a series of tips and tricks are presented to enable surgeons considering adopting this technique into their practice to do so safely and with an appreciation of the difficulties that they may face.

show abstract

Section: Review Articlementioning

confidence: 99%

Section: Case Selectionmentioning

confidence: 99%

Section: Instrumentsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Tips and tricks for success in subxiphoid video-assisted thoracic surgery

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

Uniportal subxiphoid bilateral removal of self-introduced thoracic foreign bodies

Sahdev

Punjabi

Williams

et al. 2020

Journal of Surgical Case Reports

View full text Add to dashboard Cite

This is a report of a 31-year-old male refugee, who was admitted to Intensive Therapy Unit after being found in severe chest pain after escaping extreme torture from his home country. He was found to have four nails in his thorax. These were removed using a subxiphoid video-assisted thorascopic surgery (VATS) technique. This technique allowed excellent visualization of the right, left and anterior mediastinal part of the chest and therefore preventing damage or injury to surrounding structures. This was particularly useful in a complex case such as this. By avoiding an intercoastal incision and intercostal manipulation, our patient had limited pain post-procedure facilitating an earlier aggressive mobilization program with potential benefit in terms of improved lung expansion, reduction of atelectasis and lung infections. With the right training, the technical challenges of using the technique should be overcome and thus the benefits of subxiphoid VATS will be offered to a larger portion of thoracic surgical patients.

show abstract

Opioid-free anesthesia compared to opioid anesthesia for lung cancer patients undergoing video-assisted thoracoscopic surgery: A randomized controlled study

Zhang

Chen

et al. 2021

PLoS ONE

View full text Add to dashboard Cite

Background Reducing intra-operative opioid consumption benefits patients by decreasing postoperative opioid-related adverse events. We assessed whether opioid-free anesthesia would provide effective analgesia-antinociception monitored by analgesia index in video-assisted thoracoscopic surgery. Methods Patients (ASA Ⅰ-Ⅱ, 18–65 years old, BMI <30 kg m−2) scheduled to undergo video-assisted thoracoscopic surgery under general anesthesia were randomly allocated into two groups to receive opioid-free anesthesia (group OFA) with dexmedetomidine, sevoflurane plus thoracic paravertebral blockade or opioid-based anesthesia (group OA) with remifentanil, sevoflurane, and thoracic paravertebral blockade. The primary outcome variable was pain intensity during the operation, assessed by the depth of analgesia using the pain threshold index with the multifunction combination monitor HXD‑I. Secondary outcomes included depth of sedation monitoring by wavelet index and blood glucose concentration achieved from blood gas. Results One hundred patients were randomized; 3 patients were excluded due to discontinued intervention and 97 included in the final analysis. Intraoperative pain threshold index readings were not significantly different between group OFA and group OA from arriving operation room to extubation (P = 0.86), while the brain wavelet index readings in group OFA were notably lower than those in group OA from before general anesthesia induction to recovery of double lungs ventilation (P <0.001). After beginning of operation, the blood glucose levels in group OFA increased compared with baseline blood glucose values (P < 0.001). The recovery time and extubation time in group OFA were significantly longer than those in group OA (P <0.007). Conclusions This study suggested that our OFA regimen achieved equally effective intraoperative pain threshold index compared to OA in video-assisted thoracoscopic surgery. Depth of sedation was significantly deeper and blood glucose levels were higher with OFA. Study’s limitations and strict inclusion criteria may limit the external validity of the study, suggesting the need of further randomized trials on the topic. Trial registration: ChiCTR1800019479, Title: "Opioid-free anesthesia in video-assisted thoracoscopic surgery lobectomy".

show abstract

Anesthesia and enhanced recovery in subxiphoid video-assisted thoracoscopic surgery

Cited by 3 publications

References 20 publications

Tips and tricks for success in subxiphoid video-assisted thoracic surgery

Tips and tricks for success in subxiphoid video-assisted thoracic surgery

Uniportal subxiphoid bilateral removal of self-introduced thoracic foreign bodies

Opioid-free anesthesia compared to opioid anesthesia for lung cancer patients undergoing video-assisted thoracoscopic surgery: A randomized controlled study

Contact Info

Product

Resources

About