Awake Single-Access (Uniportal) Video-Assisted Thoracoscopic Surgery for Peripheral Pulmonary Nodules in a Complete Ambulatory Setting

Rocco, Gaetano; Romano, Vittorio; Accardo, Rosanna; Tempesta, Alfonso; Manna, Carmine La; Rocca, Antonello La; Martucci, Nicola; Aiuto, Massimiliano D'; Polimeno, Emilia

doi:10.1016/j.athoracsur.2010.01.087

Cited by 83 publications

(52 citation statements)

References 9 publications

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“…In addition, some high-risk patients are excluded for thoracic surgery due to functional limitation, but experience has been acquired with awake non-intubated procedures in severe emphysematous patients for lungvolume reduction surgery that allows these compromised patients to be performed pulmonary resections (6,7). In a step-forward to a less invasive approach, non-intubated single-incision procedures [non-intubated single-incision video-assisted thoracic surgery (NI-SI-VATS)] are slowly expanding, mainly in Asia and Europe (8)(9)(10)(11)(12). There is still a lack of comparative and multicenter studies, therefore the evidence is limited when comparing to multiportal VATS under spontaneous breathing and standard intubatedventilated procedures.…”

Section: Original Articlementioning

confidence: 99%

Non-intubated single-incision video-assisted thoracic surgery: a two-center cohort of 188 patients

et al. 2017

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Background: Non-intubated single-incision procedures are slowly expanding because of high experience and skill required, and stricter selection criteria. The aim of this study is to present the first retrospective two-center series in Taiwan and Spain.Methods: We performed a retrospective analysis of 188 patients undergoing non-intubated single-incision video-assisted thoracic surgery (NI-SI-VATS) procedures between July 2013 to November 2015 in two centers in Taiwan (170 patients) and Spain (18 patients) with two different anesthetic methods. Demographic data, clinicopathological features, preoperative tests, and final outcomes were analyzed to compare the outcomes with the two different techniques.Results: Of the 188 patients, 147 (78%) were women, with a mean body mass index (BMI) of 22.7. Of the 196 specimens, 145 (74%) were malignancies with a mean size of 9.7 mm. Wedge resection was performed in 172 patients (91.4%), anatomical segmentectomy with lymphadenectomy in 8 (4.7%), and lobectomy with lymphadenectomy in 5 (2.6%). Three patients (1.6%) required conversion to orotracheal intubation, while 5 patients (2.7%) required additional ports. Complications appeared in 16 patients (8.5%) with air leak as the most frequent in 7 cases (3.7%). Median chest drainage was 1 day, and median postoperative stay was 3 days.There was neither perioperative death nor postoperative readmission.Conclusions: Non-intubated single-incision procedures can be feasible and safe in expert hands and experienced teams, even for anatomical resections. Strict selection criteria, skill and experience are mandatory. Comparative cohorts and randomized trials are needed.

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Section: Original Articlementioning

confidence: 99%

Non-intubated single-incision video-assisted thoracic surgery: a two-center cohort of 188 patients

et al. 2017

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“…Pulmonary biopsies, metastatectomies and pneumothorax should first be attempted to find out the main difficulties and the possible solutions (7,19). Primary spontaneous pneumothorax patients are usually young and healthy patients with preserved cough reflex, so surgeons can safely manage the first attempts of vagal block and test the outcomes.…”

Section: Starting Pointmentioning

confidence: 99%

Nonintubated uniportal VATS pulmonary anatomical resections

Gálvez¹,

Navarro-Martínez²,

Bolufer³

et al. 2017

J. Vis. Surg.

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Reasons why and historical perspective M a j o r a n a t o m i c a l r e s e c t i o n s ( s e g m e n t e c t o m i e s , Some concerns about regional analgesia, vagal block for cough reflex control and oxygenation techniques, combined with some specific surgical tips can make safer these procedures. Specialists must remember an essential global concept: all the efforts are aimed at decreasing the invasiveness of the whole procedure in order to benefit patients' intraoperative status and postoperative recovery.

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“…NITOS may be used to perform videothoracoscopic or open wedge resection of solitary pulmonary nodules (SPN) of unknown origin [40][41][42][43][44][45][46][47][48]. It can be specifically indicated to wedge out peripherally located nodules <2 cm in size, which can be easily detected and excised even in a partially inflated lung.…”

Section: Resection Of Solitary Pulmonary Nodulesmentioning

confidence: 99%

“…Lesser et al used a two-access method with 2 and 11-mm openings and the use of a laser device to excise the nodules [46]. Alternatively, the operation may be carried out through a single, 3 to 5 cm incision (uniportal), through which all the endoscopic instrumentation is inserted coaxially with the thoracoscope [47]. We are also now starting to adopt this approach, which provides the twofold advantage of a lesser invasiveness and the possibility of some manual palpation of the nodule(s) to be removed.…”

Section: Resection Of Solitary Pulmonary Nodulesmentioning

confidence: 99%