Feasibility and Results of Awake Thoracoscopic Resection of Solitary Pulmonary Nodules

Pompeo, Eugenio; Mineo, Davide; Rogliani, Paola; Sabato, Alessandro; Mineo, Tommaso Claudio

doi:10.1016/j.athoracsur.2004.05.083

Cited by 222 publications

(204 citation statements)

References 18 publications

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“…The majority of procedure that included talc pleurodesis, this did not impact on the length of the operation as it took just 2 or 3 min more. As already described by different authors [8,[10][11], awake technique allows a reduction, although slightly, of postoperative hospital stay and duration of chest drainage, while the authors registered similar complications and recurrence rate.…”

Section: Discussionmentioning

confidence: 51%

Thoracoscopy in Pleural Effusion – Two Techniques: Awake Single-Access Video-Assisted Thoracic Surgery Versus 2-Ports Video-Assisted Thoracic Surgery Under General Anesthesia

et al. 2015

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Awake single access video-assisted thoracic surgery with local anesthesia improves procedure tolerance, reduces postoperative stay and costs. Materials & methods: Local anesthesia was made with lidocaine and ropivacaine. We realize one 20 mm incision for the 'single-access', and two incisions for the '2-trocars technique'. Results: Mortality rate was 0% in both groups. Postoperative stay: 3dd ± 4 versus 4dd ± 5, mean operative time: 39 min versus 37 min (p < 0.05). Chest tube duration: 2dd ± 5 versus 3dd ± 6. Complications: 11/95 versus 10/79. Conclusion: Awake technique reduce postoperative hospital stay and chest drainage duration, similar complications and recurrence rate. The authors can say that 'awake single-access VATS' is an optimal diagnostic and therapeutic tool for the management of pleural effusions, but above extends surgical indication to high-risk patients. KEYWORDS• awake VATS • pleural effusion • single port • VATSThe history of video-assisted thoracic surgery (VATS) utilizing the local anesthesia and sedation is almost one century old with Jacobeus and Bethune [1].The authors started an 'awake single port VATS' program because they hypothesized that the use of just one access associated with local anesthesia might be feasible and could result in a better procedure acceptance, in a more rapid recovery, in a reduced procedure-related cost and in a more less invasive procedure.A single access associated with local anesthesia aims to improve procedure tolerance, shorten recovery and reduce costs. Materials & methodsThe authors retrospectively analyzed 174 patients with pleural effusion treated by awake technique or general anaesthesia. At admission, patients underwent complete laboratory assay, blood gases, chest roentgenograms, ectrocardiogram and eventually chest computed tomography (CT) scan and cardiological evaluation. An informed consent was obtained from all patients, including possibility of endotracheal intubation and thoracotomy. Premedication consisted in atropine 0.01 mg/kg and ondansetron 8 mg. Pain control and sedation were obtained by remifentanile (0.05-0.1 μg/kg/min) and midazolam (0.02-0.04 mg/kg). In the operating room, the patient was turned to a full lateral decubitus position and the table was flexed to widen the rib spaces on the operation side. A small antidecubitus mattress was placed below the dependent hemitorax to obtain a slight splitting of intercostal spaces without patient's discomforts. The position of the lonely trocar was usually defined with the help of utrasound (US). The using of US to choose the site of access was a rapid and safe method that helped to visualize the pleural effusion and that guided the operator to define the site of access, keeping away from some 'hazardous areas.' A line which included the plan of incision was drawn and the standard antiseptic procedure was performed. Local anesthesia was obtained with For reprint orders, please contact: reprints@futuremedicine.com

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Section: Discussionmentioning

confidence: 51%

Thoracoscopy in Pleural Effusion – Two Techniques: Awake Single-Access Video-Assisted Thoracic Surgery Versus 2-Ports Video-Assisted Thoracic Surgery Under General Anesthesia

et al. 2015

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“…In our center, awake surgeries have been carried out in more than 1,000 cases, with their feasibility and safety well explored (5). Since the awake technique was reported by Pompeo et al (6) in 2004, it has increasingly been applied in routine thoracic surgeries including lung wedge resection, resection of bullae, and pulmonary lobectomy (7,8). During physical needs drive the intercostal muscles and diaphragm to move, enabling the high-concentration oxygen to effectively enter the bilateral main bronchi for oxygenation, followed by the discharge of carbon dioxide.…”

Section: Preoperative Pulmonary Function Tests Prompted Thatmentioning

confidence: 99%

Non-intubated combined with video-assisted thoracoscopic in carinal reconstruction

Peng

Cui

Ang³

et al. 2016

J. Thorac. Dis.

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Abstract:Carinal reconstruction is a difficult technique combined with video-assisted thoracoscopic surgery (VATS). It has a high requirement on the operator's skills in operating thoracoscope and meanwhile requires the close cooperation from anesthesiologists. Tracheal intubation and ventilator-assisted ventilation are key steps to ensure the success of surgery. However, tracheal intubation itself may influence the exposure of surgical field and increase the difficulty of anastomosis. In close cooperation of anesthesiologists, we did not perform tracheal intubation; rather, we carried out non-intubated complete VATS carinal reconstruction in a patient with adenoid cystic carcinoma (ACC) of the lower trachea. The awake complete VATS carinal reconstruction was successfully performed. The anastomosis lasted about 36 hours, and the whole surgical procedure lasted 230 min. The intraoperative blood loss was about 80 mL. The patient recovered well 100 min after surgery. A semi-solid diet began 6 hours following the surgery. This non-intubated anesthesia method makes the surgery easier, especially during the anastomosis of stumps. It is feasible and safe to apply this anesthesia technique in carinal reconstruction.

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“…We therefore now prefer videoassisted thoracoscopic surgery management with the goal of sealing pulmonary tears and reducing the risks of triggering further complications. In addition, having further experience with awake procedures for resection of pulmonary nodules [9] and LVRS [10], we are prone to adopt this option even in this setting, with the aim of reducing surgical risks in these delicate patients. Previous studies have focused on the advantages of this approach to managing air leak problems [11,12].…”

Section: Commentmentioning

confidence: 99%

Late-Onset Occult Pneumothorax After Lung Volume-Reduction Surgery

Tacconi

Pompeo

Mineo

2005

The Annals of Thoracic Surgery

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Background. Lung volume-reduction surgery has proved to be a reliable palliative surgical treatment for patients with severe emphysema. Nonetheless, late complications can arise after lung volume-reduction surgery although this matter has been poorly investigated by previous studies.Methods. We report a series of 6 patients undergoing unilateral lung volume-reduction surgery at our institution between October 1995 and December 2004, who were readmitted several months after discharge because of the occurrence of occult pneumothorax mimicking acute respiratory failure.Results. Occult pneumothorax occurred in 3.3% of the 182 patients treated with lung volume-reduction surgery at our institution. Patients were readmitted after a mean of 94 days (range, 20 to 700 days) from the discharge. Chest roentgenography was unable to detect the occurrence of pneumothorax, which was instead revealed by means of a computed tomographic scan in all patients.

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Feasibility and Results of Awake Thoracoscopic Resection of Solitary Pulmonary Nodules

Cited by 222 publications

References 18 publications

Thoracoscopy in Pleural Effusion – Two Techniques: Awake Single-Access Video-Assisted Thoracic Surgery Versus 2-Ports Video-Assisted Thoracic Surgery Under General Anesthesia

Thoracoscopy in Pleural Effusion – Two Techniques: Awake Single-Access Video-Assisted Thoracic Surgery Versus 2-Ports Video-Assisted Thoracic Surgery Under General Anesthesia

Non-intubated combined with video-assisted thoracoscopic in carinal reconstruction

Late-Onset Occult Pneumothorax After Lung Volume-Reduction Surgery

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