Non-intubated video-assisted thoracic surgery for subxiphoid anterior mediastinal tumor resection

Abstract

Background: Subxiphoid approach for mediastinal tumor resection was reported to provide a better view and less postoperative pain. Non-intubated video-assisted thoracic surgery (NI-VATS) without muscle relaxant would decrease the possibility of postoperative airway collapse for anterior mediastinal mass operation. Herein, we sought to describe the use of NI-VATS through subxiphoid approach for anterior mediastinal tumor resection. Methods: In this retrospective cohort study, patients that underwent subxiphoid VATS resection for anterior mediastinal tumor between December 2015 and September 2019 were divided into two groups: NI-VATS and intubated VATS (I-VATS). Intraoperative and postoperative variables were compared. Results: A total of 40 patients were included. Among them, 21 patients received NI-VATS (52.5%) and 19 were treated with I-VATS (47.5%). In total, intraoperative (4/21 vs. 2/19; P=0.446) and postoperative complications (5/21 vs. 7/19; P=0.369) were similar between NI-VATS and I-VATS group. The anesthesia time (231.76 vs. 244.71 min; P=0.218), the operation time (152.35 vs. 143.64 min; P=0.980), chest tube duration (1.81 vs. 1.84 days; P=0.08), the total volume (351.95 vs. 348.00 mL; P=0.223), post-operative pain scores (2.79 vs. 2.93, P=0.413), and the length of stay (9.47 vs. 10.57 days; P=0.970) were all comparable between two groups.Conclusions: NI-VATS for mediastinal tumor resection via subxiphoid approach is a safe and technically feasible option in selected patients, which leads to comparable perioperative clinical outcomes when compared with I-VATS via the subxiphoid approach. This technique could be used as an alteration when intubation is not available.

The Anesthesiologist's Perspective Regarding Non-intubated Thoracic Surgery: A Scoping Review

“…Of the studies analyzed, 42.4% used intercostal nerve block, 40.7% thoracic epidural analgesia, 6.8% paravertebral block, 5.1% infiltration with local anesthetic of the wound, 3.4% erector spinae plane block, and 1.6% placed a catheter at the paravertebral site for continuous analgesia. Evaluating NITS vs. non-NITS cohort studies the postoperative pain was significantly lower in the NITS group in five studies ( 3 , 6 , 14 , 15 , 22 ), whereas the findings were not statistically significant in six studies ( 19 , 21 , 25 , 28 , 31 , 32 ).…”

Clinical analysis of subxiphoid vs. lateral approaches for treating early anterior mediastinal thymoma

“…Nonintubated subxiphoid uniportal video-assisted thoracoscopic thymectomy was more consistent with the therapy of enhanced recovery after surgery (ERAS), aimed to reduce pain and hospital cost. A retrospective study was conducted by Mao et al ( 26 ), in which a total of 40 patients underwent VATS thymectomy, with 21 patients undergoing nontracheal intubation (NI-VATS) and 19 tracheal intubation (I-VATS). Intraoperative and postoperative complications were similar in both groups, while the NI-VATS group had significant advantages in terms of anesthesia time, operative time, extubation time, total drainage volume, and postoperative pain scores.…”

Thoracoscopy-assisted treatment for mediastinal metastasis of thyroid cancer: a case report

“…With the favorable magnification and lighting functions of the endoscope, the tumors can be removed more thoroughly and with less trauma, more rapid recovery, and a more reliable effect. [12][13][14][15][16] However, the application of three-port thoracoscopy under the xiphoid process to assist the performance of a cervical incision in the treatment of upper mediastinal lymph node metastasis of thyroid cancer has rarely been reported. In this case, preoperative enhanced CT of the neck showed that the lymph nodes in stations VI and VII of the left neck were fused into a mass, deeply positioned, and closely adhered to the left innominate vein.…”