Nonintubated Versus Intubated Uniportal Thoracoscopic Segmentectomy for Lung Tumors

Liu, Hao-Yun; Hsu, Hsao‐Hsun; Tsai, Tsung Han; Chiang, Xu-Heng; Lu, Tzu-Pin; Chang, Chun-Lung; Chen, Pei-Hsing; Wang, Manling; Hung, Ming-Hui; Cheng, Ya-Jung; Lin, Min; Chen, Jin‐Shing

doi:10.1016/j.athoracsur.2020.06.058

Cited by 17 publications

(28 citation statements)

References 24 publications

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“…A meta-analysis involving more than 1,600 patients reached similar conclusions (13). Overall, SV-VATS has shown unique advantages in both mediastinum (14) and pulmonary surgery (15). However, these studies were limited to evaluating hospital stay, thoracic drainage time, postoperative complications and other outcomes, lack of exploration of the factors that contribute to these outcomes.…”

Section: Discussionmentioning

confidence: 85%

SV-VATS exhibits dual intraoperative and postoperative advantages

Xu¹,

Li²,

Ning³

et al. 2021

Ann Transl Med

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Background: The merits of spontaneous ventilation video-assisted thoracic surgery (SV-VATS) are still controversial. Our team retrospectively evaluated the intraoperative and postoperative advantages of this surgical approach, comparing with mechanical ventilation video-assisted thoracic surgery (MV-VATS).Methods: We did a single center retrospective study at the First Affiliated Hospital of Yunnan Province. 244 patients were eventually assigned to the SV-group and MV-group, and their intraoperative indicators and thoracic surgery postoperative data were included in the comparison. Results:The SV-group exhibited markedly less intraoperative bleeding and postoperative thoracic drainage, and the bleeding volume was correlated with the volume and duration of drainage. Further analysis showed that, patients undergoing SV-VATS had less activation of white blood cells and neutrophils after surgery, but they also had lower serum albumin concentrations. Risks of short-term postoperative complications, including inflammatory reactions, malignant arrhythmias, constipation, and moderate or more pleural effusions, were also significantly reduced in the SV-group. Additionally, hospitalization cost was lower in the SV-group than that in the MV-group.Conclusions: SV-VATS is suitable for various types of thoracic surgery, and effectively reduce intraoperative bleeding and postoperative thoracic drainage. With less postoperative inflammatory response, it reduces the risk of short-term postoperative complications. It is also able to help to reduce the financial burden of patients.

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Section: Discussionmentioning

confidence: 85%

SV-VATS exhibits dual intraoperative and postoperative advantages

Xu¹,

Li²,

Ning³

et al. 2021

Ann Transl Med

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“…Searching PubMed and Cochrane Library since 2019 when we wrote the manuscript ( 14), shows that only 3 new results have been published regarding nonintubated anatomical segmentectomy: one meta-analysis (15), one comparative retrospective study (11), and one case series (16). This little evidence means that there have been very few advances on this combination of minimally invasive techniques.…”

Section: Methodsmentioning

confidence: 99%

“…The comparison focused on the surgical approach but not the anesthetic method. This same group from Taiwan, published the actual year (11), a retrospective analysis of 185 consecutive uniportal VATS anatomical segmentectomies in a 5-year period [2014][2015][2016][2017][2018][2019], 50 of them were nonintubated. They performed a propensity score matching of 43 cases in each arm.…”

Section: Methodsmentioning

confidence: 99%

“…If we look at data published from the propensity score matching of 43 nonintubated and 43 intubated segmentectomies by Liu et al (11), there were no conversions to intubation or thoracotomy, and no significant differences in conversion to multiportal VATS due to extense adhesions (4.7% vs. 2.3%, P=0.557). There were also no differences in lowest oxygen saturation measured by oximetry (97.1±3.7 vs. 97.2±3.7, P=0.743), but what is most important no significant differences were noted in peak end tidal carbon dioxide during procedures (42.9±7.5 vs. 43.6±4.8, P=0.633).…”

Section: Are Nonintubated Anatomical Segmentectomies Safe?mentioning

confidence: 99%

“…Nonintubated anatomical resections under spontaneous breathing in low-risk patients have been performed but are limited to a few highly experienced centers mainly in Asian countries (10)(11)(12). There are still many concerns about indications, technical details, and potential advantages and risks that should be first addressed (13).…”

Section: Introductionmentioning

confidence: 99%

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Nonintubated anatomical segmentectomy: does the benefit overcome the risks?—a narrative review

Gálvez¹,

Bolufer²,

Corcoles³

et al. 2022

J Vis Surg

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Objective: Search the evidence available regarding nonintubated anatomical segmentectomies and discuss about outcomes.Background: Nonintubated thoracic surgery has evolved since initial "rescue procedures" for highrisk patients under awake anesthesia, until sedative nonintubated resections including anatomical segmentectomies. Nonetheless, very few experienced centers in Asia have collected most of this short caseload worldwide, thus reflecting the difficult advance in this very specific minimally-invasive procedure. In fact, the evidence about nonintubated segmentectomies suggests only little benefits in terms of postoperative recovery (chest tube duration, hospital stay). Methods:We review comparative studies, randomized trials, systematic reviews and meta-analysis about nonintubated segmentectomies since its first report. We focused in some controversial aspects and which the conclusions should be.Conclusions: Evidence regarding the potential benefit of nonintubated segmentectomies is really poor nowadays due to very few studies reported from just highly-experienced centers. The evidence points to a better postoperative recovery in terms of chest tube duration and hospital stay, but these advantages are limited by non-randomized design and methodological biases. Nonetheless the standard with general anesthesia and orotracheal intubation is highly safe in the low-risk cohort of patients strictly selected for nonintubated segmentectomies, so it seems that the expected advantages of this anesthetic method have not been reached or at least not been assessed, especially those regarding respiratory complications and stress biomarkers. Efforts should be made in order to clarify the concepts and the targeted population, homogenize the anesthetic methods, design randomized trials assessing the variables where the expected benefits can be measured, and state conclusion according to these outcomes.

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