Four-Step Local Anesthesia and Sedation for Thoracoscopic Diagnosis and Management of Pleural Diseases

Migliore, Marcello; Giuliano, Riccardo; Aziz, Tarek; Saad, Rasheed A.; Sgalambro, Francesco

doi:10.1378/chest.121.6.2032

Cited by 64 publications

(35 citation statements)

References 7 publications

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“…Due to the well-known geometrical advantages, uniportal VATS allows for good exposure and adequate resection of the affected areas of the lung (12). Keys to achieving success in uniportal approach are the angled (30°) thoracoscope and roticulator staplers (9)(10)(11). With the use of these instruments, the skin incision and the compression on the intercostal nerve can be kept to a minimum (13).…”

Section: Discussionmentioning

confidence: 99%

Uniportal video-assisted thoracic surgery for pneumothorax and blebs/bullae

et al. 2017

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Abstract:The last British Society of Thoracic Surgeons guidelines of 2010 for the management of primary spontaneous pneumothorax (PSP) stated that, after the first recurrence, the treatment of PSP should be a surgical operation, like a bullectomy accompanying with a procedure for inducing pleural adhesions. Therefore, the surgical approach is considered the best treatment to minimise the risk of recurrence in patients who experienced a PSP. There is substantial evidence in the literature demonstrating that the minimally invasive approach should be preferred to the thoracotomic procedure since it can reduce the postoperative pain and it is associated with a faster recovery of the physical and working activity. The video-assisted thoracic surgery (VATS) approach has been shown to offer greater advantages about patient pain and respiratory function when compared to thoracotomic incisions. A single port or single incision or uniportal approach was developed as an alternative to the standard multi-port VATS. Uniportal technique has shown to be safe and efficient not only for pulmonary resections and biopsies but also for lobectomy.When used for PSP, the bullectomy/blebectomy and pleural abrasion/pleurectomy is performed through the single incision through which the chest drain is then inserted. In this perspective, evidence showed that the minimally invasive approach should be preferred, confirming the advantages in comparison with traditional techniques. blebectomy and pleural abrasion/pleurectomy is performed through the single incision through which the chest drain is then inserted (3). In this perspective, evidence showed that the minimally invasive approach should be preferred, confirming the advantages in comparison with traditional techniques (4).Here we described the theoretical aspects of the uniportal VATS approach for PSP. Surgical techniqueUniportal VATS allows performing all the main surgical steps recommended for treating patients affected by PSP with the same clinical advantages of the traditional three-port VATS. The VATS technique achieves the exploration of the chest cavity and the lung parenchyma to find blebs/bullae, to resect the diseased areas of the lung, and to perform adequate pleurodesis procedures (e.g., mechanical parietal pleural abrasion, talc poudrage, pleurectomy, etc.) (2).Patient decubitus is in the lateral position. Otherwise, from the standard three-port VATS approach, where the lesion represents the peak of an ideal pyramid, and the camera and instruments are placed in correspondence of the other three pinnacles, the uniportal VATS technique implies that the target, the thoracoscope, and the instruments all lie in the same sagittal plane. Although the single incision is the fulcrum where the parallel devices reach the target, arranging themselves in a craniocaudal direction (5), the surgeon should be free to move inside the chest cavity without the boundaries due to an unfavourable geometry (6). A 1.5-2 cm skin incision at the sixth intercostal space along the middle axillary line...

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Section: Discussionmentioning

confidence: 99%

Uniportal video-assisted thoracic surgery for pneumothorax and blebs/bullae

et al. 2017

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“…Literatüre baktığımızda uyanık hastada yapılan VATS operasyonlarında genellikle lateral torakotomi pozisyonu tercih edilmektedir [4,5]. Biz ise hasta konforu ve hava yolunun daha rahat yönetimi için yarı oturur pozisyonu tercih ettik.…”

Section: Discussionunclassified

“…Migliore ve ark. 'ları [5] talk pudra verdikleri 28 hastadan 2'sinde fazla miktarda ağrı olduğunu ve bu sebepten rutin uygulamada plöridezis vakalarında daha derin sedasyon yaptıklarını bildirmişlerdir. Bizim olgularımızda böyle bir şikayet olmadığı için talk plöridezis yapı-lanlarla yapılmayanlara eşit dozda sedasyon uyguluyoruz.…”

Section: Discussionunclassified

The Role of Awake VATS in Diagnosis and Treatment of Pleural Effusions

Karadayı¹,

Fındıkçıoğlu²,

Kılıç³

et al. 2013

Tur Toraks Der

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AMAÇ: Video Yardımlı Torakoskopik Cerrahi (VATS) çoğunlukla genel anestezi altında ve çift lümenli endotrakeal tüplerle yapıl-maktadır. Ancak bazı plevral ve pulmoner patolojilerde hastayı genel anestezinin risklerinden korumak için sedasyon ve lokal anestezi ile VATS uygulamaları da yapılabilmektedir. Çalışmamız-da sedoanaljezi ile yaptığımız VATS operasyonlarının torasik patolojilerin tanı ve tedavisindeki rolü değerlendirildi. GEREÇ VE YÖNTEMLER:Bu çalışmaya Ocak 2007Aralık 2011 tarihleri arasındaki 5 yıllık periyodda sedasyon ve lokal anestezi ile VATS uyguladığımız 101 hasta dahil edildi. Hastaların tümü ameliyathanede ve yarı oturur pozisyonda opere edildiler. Plevra boşluğuna girmek için 11 mm çapında portlar ve 5 mm çaplı 30 derecelik torakoskop kullanıldı. Sedasyon için 0,5 mg/kg propofol, 0,51 µcg/kg fentanil, 12 mg midazolam intravenöz yoldan uygulandı. Gereğinde propofol tekrarlandı. Lokal anestezi için 10 cc prilokain HCl (20 mg/mL) uygulandı. BULGULAR:Altmış yedi erkek, 34 kadın hastanın yaşları 17 ile 88 arasında değişmekteydi. Seksen dört hastaya (%83,2) eksplorasyon, drenaj ve plevra biyopsisi; 10 hastaya (%9,9) drenaj ve plevra biyopsisine ek olarak talk plöridezis; 4 hastaya (%4) ampiyem drenajı ve fibrin debrislerin temizlenmesi, 2 (%1,9) hastaya hematom boşaltılması, 1 hastaya (%1) diafragmatik porların kapatılması işle-mi uygulandı. Doksan hastaya (%89,1) tek portla VATS, 11 hastaya (%10,9) ise 2 portla VATS yapıldı. Dört hasta (%4) sedasyonla lokal anesteziyi tolere edemediği için genel anesteziye geçildi (3 hastada şiddetli öksürük ve 1 hastada plevral yapışıklıklar nedeniyle). Cerrahi komplikasyonlar nedeniyle hiçbir hastada acil torakotomi gerekmedi. SONUÇ:Sedoanaljezi ile VATS operasyonları, plevral patolojilerin tanı ve tedavisinde güvenli bir şekilde yapılabilmektedir.ANAhTAR SÖzcükLER: Videotorakoskopi, plevra hastalıkları, sedoanaljezi OBJEcTIVE: Videoassisted thoracic surgery (VATS) is usually performed under general anaesthesia. However, some pleural and pulmonary interventions may be performed under local anaesthesia with sedation. In this study, patients who underwent VATS without general anaesthesia were evaluated to determine the benefits and safety of the procedure. MATERIAL AND METhODS:The medical records of all patients who underwent VATS with local anaesthesia and sedation between January 2007 and December 2011 were reviewed. All procedures were performed with the patient in a semirecumbent position in an operating room. PrilocaineHCl (20 mg/mL; 10 cc) was used for local anaesthesia. Sedation was obtained with intravenous administration of propofol (0.5 mg/kg), fentanyl (0.51 µg/kg) and midazolam (12 mg in total). RESULTS:There were 67 male and 34 female patients, ranging from 17 to 88 years of age. Most of the awake VATS procedures were performed to evaluate pleural disease (93 patients; 92.0%). Pleural biopsy and/or drainage was performed in 84 patients (83.2%), pleural biopsy/drainage with talc pleurodesis in 10 patients (9.9%), treatment of empyaema in fourpatients (4...

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“…Locoregional anaesthesia and sedation, such as local wound infiltration or selective intercostal nerve blockade would be sufficient for intra-and postoperative pain control of minor thoracoscopic procedures, and can even achieve satisfying anaesthesia in obese patients (22,23). However, major procedures warrant sophisticated anaesthesia techniques.…”

Section: Anaesthetic Setting In Nitsmentioning

confidence: 99%

Anaesthesiology for uniportal VATS: double lumen, single lumen and tubeless

Zhao

Lau

2017

J. Vis. Surg.

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Abstract:The advent of one-lung ventilation (OLV) technique provides immobilized surgical field which is fundamental in minimally invasive thoracic surgery. Mainstem methods of achieving lung separation are either via a double-lumen endotracheal tube or placing a bronchial blocker (BB) through a single-lumen endotracheal tube. More recently, the use of non-intubated thoracic surgery (NITS) has been investigated intensively, attempting to minimise the complications that follow general anaesthesia. The aim of this review is to describe the mechanism of these techniques briefly and outlines the advantages and drawbacks of them with the comparison.

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Four-Step Local Anesthesia and Sedation for Thoracoscopic Diagnosis and Management of Pleural Diseases

Cited by 64 publications

References 7 publications

Uniportal video-assisted thoracic surgery for pneumothorax and blebs/bullae

Uniportal video-assisted thoracic surgery for pneumothorax and blebs/bullae

The Role of Awake VATS in Diagnosis and Treatment of Pleural Effusions

Anaesthesiology for uniportal VATS: double lumen, single lumen and tubeless

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