Oncological advantage of nonintubated thoracic surgery: Better compliance of adjuvant treatment after lung lobectomy

Furák, József; Paróczai, Dóra; Burián, Katalin; Szabó, Zsolt; Zombori, Tamás

doi:10.1111/1759-7714.13672

Cited by 27 publications

(26 citation statements)

References 40 publications

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“…Considering the oncological adequacy of NITS procedures, most of the studies dealing with NITS major lung resections reported no significant differences about lymph node dissection; only one of the above reported studies showed a significant difference regarding the The study reported an oncological advantage in NITS patients, showing better compliance with therapy protocols and fewer events of toxicity: these results can be related to a better physiological inflammatory and cellular immune response and fewer immunodepressive effects after a less invasive surgical procedure and a shorter hospital stay. Even though further studies are needed to investigate the relation of NITS and oncological advantages after surgery in NSCLC, these results support the benefits of minimal invasiveness on adjuvant chemotherapy (29).…”

Section: Discussionmentioning

confidence: 66%

Major lung resections with spontaneous ventilation: a narrative review

Diotti¹,

Tosi²

2022

AME Surg J

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In the last decades, technical improvements and the advance of innovative technologies have made thoracic surgery increasingly less invasive: video-assisted thoracic surgery (VATS) is now considered the best approach for early-stage non-small cell lung cancer (NSCLC) surgical treatment, and has become the first choice for many non-oncological thoracic diseases requiring surgery, with proved advantages in terms of less post-operative pain, fewer complications and a faster recovery. Combining minimally invasive surgical and anaesthetic techniques is one of the new frontiers of thoracic surgery: in this scenario nonintubated thoracic surgery (NITS) is a promising approach to minimize risks related to general anaesthesia and intubation, promote a faster recovery and reduce hospital stay. Since its first reported applications for minor thoracic procedures in the late 90s, NITS has emerged as a promising technique and it is recently being applied also to technical demanding major thoracic anatomical resections, such as lobectomies and segmentectomies, with encouraging results concerning feasibility, perioperative outcomes and complication rates. The oncological value of NITS is also being explored: recent studies show better compliance with adjuvant chemotherapy protocols and fewer events of toxicity in patients treated with NITS procedures. The aim of this narrative review is to investigate the role of NITS applied to major lung resections in terms of feasibility, short-term outcomes and applications in everyday clinical practice.

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Section: Discussionmentioning

confidence: 66%

Major lung resections with spontaneous ventilation: a narrative review

Diotti¹,

Tosi²

2022

AME Surg J

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“…Moreover, a recent study from our group by Furák et al found oncological benefits with the NITS method, as a significantly greater proportion of non-intubated patients was able to complete the planned adjuvant chemotherapy and significantly less toxicity and neutropenia occurred among them (8).…”

Section: Advantages Of Nitsmentioning

confidence: 88%

“…Traditionally, video-assisted thoracic surgery (VATS) procedures require general anesthesia, muscle relaxation, and controlled ventilation with lung isolation. In recent years, the increasingly researched non-intubated techniques have become a safe and feasible alternative, with a less intense immunological response (5-7) and better oncological compliance (8). The key anesthetic consideration behind the non-intubated technique is the maintenance of spontaneous breathing with its advantageous effects on respiration during thoracoscopic or even open thoracic procedures (9)(10)(11)(12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Non-intubated Thoracoscopic Surgery-Tips and Tricks From Anesthesiological Aspects: A Mini Review

et al. 2022

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BackgroundIn the last few decades, surgical techniques have been developed in thoracic surgery, and minimally invasive strategies such as multi-and uniportal video-assisted thoracic surgery (VATS) have become more favorable even for major pulmonary resections. With this surgical evolution, the aesthetic approach has also changed, and a paradigm shift has occurred. The traditional conception of general anesthesia, muscle relaxation, and intubation has been re-evaluated, and spontaneous breathing plays a central role in our practice by performing non-intubated thoracoscopic surgeries (NITS-VATS).MethodsWe performed a computerized search of the medical literature (PubMed, Google Scholar, Scopus) to identify relevant articles in non-intubated thoracoscopic surgery using the following terms [(non-intubated) OR (non-intubated) OR (awake) OR (tubeless) OR (regional anesthesia)] AND [(VATS) OR (NIVATS)], as well as their Medical Subject Headings (MeSH) terms.ResultsBased on the outcomes of the reviewed literature and our practice, it seems that pathophysiological concerns can be overcome by proper surgical and anesthetic management. All risks are compensated by the advantageous physiological changes that result in better patient outcomes. With the maintenance of spontaneous breathing, the incidence of potential adverse effects of mechanical ventilation, such as ventilator-induced lung injury and consequent postoperative pulmonary complications, can be reduced. The avoidance of muscle relaxants also results in the maintenance of contraction of the dependent hemidiaphragm and lower airway pressure levels, which may lead to better ventilation-perfusion matching. These techniques can be challenging for surgeons as well as for anesthetists; hence, a good knowledge of physiological and pathophysiological changes, clear inclusion and exclusion and intraoperative conversion criteria, and good communication between team members are essential.ConclusionNITS-VATS seems to be a feasible and safe method in selected patients with evolving importance as a part of the minimally invasive surgical and anesthetic conception and has a role in reducing perioperative complications, which is crucial in the thoracic surgical patient population.

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“…The intrinsic development of the spontaneous ventilation VAT S h a s b e e n a c c u r a t e l y d e s c r i b e d ( 1 0 ) . T h e anaesthesiological proportion has been clearly evaluated (11,12) and the oncological aspect of the method is finally emerging (13). Many particular approaches through the appropriate thoracic region into the relevant intrathoracic field are widely documented in current literature (14).…”

Section: The Proceduresmentioning

confidence: 99%

Essentials in spontaneous ventilation video-assisted thoracoscopic surgery: how we do it

Horváth¹,

Hudacek²

2022

AME Surg J

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Spontaneous ventilation non-intubated video-assisted thoracic surgery (NITS) has roots in authentic tradition, and yet is radically new. It appreciates inherent physiological functions and engages upto-date knowledge of physiology, pharmacology, and device technology. The interdisciplinary collaboration between surgery and anaesthesia is refined. The compliance of the lungs and the thoracic wall is supported by high-flow nasal oxygenation (HFNO). The depth of anaesthesia with propofol is monitored by bispectral index (BIS). BIS score is optimally maintained between 40-60. The procedures include foreign body extraction, pulmonary wedge resections, thoracic wall or mediastinal tumours extirpation, anatomical pulmonary resection, lobar or sublobar, up to pneumonectomy. The method significantly reduces preoperative preparation and postoperative care. During the preparatory stage of the operation, artificial pneumothorax (PNO) is introduced under propofol sedation and HFNO performing the utility incision(s) in local anaesthesia. Bupivacaine and lidocaine are used. Then inner intercostal regional anaesthesia in the third to the eighth intercostal space is administered. A vagal block follows using a sheathed long needle.Thereafter, routine thoracic surgery continues without any technical difference in comparison with established video-assisted thoracoscopic surgery (VATS) with intubation and artificial breathing. NITS has one specific feature: the three types of unwitting pulmonary, mediastinal and thoracic wall movement than can emerge after PNO introduction: 1/mild, 2/moderate, 3/severe (significant). It is not possible to predict which of these will appear. In mild and moderate types (about 90% of patients) every kind of procedure is feasible. The severe type signals the need for conversion to an intubation procedure with artificial breathing. Contraindications of NITS include obesity, gastroesophageal reflux disease, large pleural adhesions, significant pulmonary movement.

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Oncological advantage of nonintubated thoracic surgery: Better compliance of adjuvant treatment after lung lobectomy

Cited by 27 publications

References 40 publications

Major lung resections with spontaneous ventilation: a narrative review

Major lung resections with spontaneous ventilation: a narrative review

Non-intubated Thoracoscopic Surgery-Tips and Tricks From Anesthesiological Aspects: A Mini Review

Essentials in spontaneous ventilation video-assisted thoracoscopic surgery: how we do it

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