Tubeless major pulmonary resections

Abstract

From its inception, cutting edge minimally invasive thoracic surgery has pursued to barely produce patient perturbation. Although state of the art techniques such as uniportal approach have achieved a remarkable reduction in postoperative morbidity, there is still a way to go in patient comfort. A new 'tubeless' concept has surfaced as an alternative to double-lumen intubation with general anaesthesia combining non-intubated spontaneous breathing video-assisted thoracic surgery (VATS) surgery under locoregional blockade with the avoidance of central line, epidural or urinary catheter and chest tube in selected patients. Those procedures combine the most evolved and less invasive techniques in anaesthesia, videoassisted surgery and perioperative care to cause the least trauma and allow for faster recovery. Non-intubated thoracic surgery used to rise some concerns regarding spontaneous breathing collapse, oxygenation, cough reflex triggering and mediastinal shift. Today, experienced teams in high-volume centers have proven nonintubated major lung resections are feasible and safe once those drawbacks have been overcome with the proper techniques and extensive previous expertise in VATS. Tubeless thoracic surgery is currently evolving, challenging former exclusion criteria and expanding indications to major lung resections or even tracheal and carinal resections to provide better intraoperative status and promote minimal need for recovery.

Thoracoscopic lung biopsy under regional anesthesia for interstitial lung disease

“…These patients have poor respiratory reserve which makes them susceptible to pulmonary complications after GA and lung isolation due to a number of factors such as derecruitment and associated atelectrauma of the diseased lung as well as neuromuscular blockade 4. Recently, VATS has been described under monitored anesthesia care (MAC) with or without neuraxial anesthetic supplementation in an attempt to minimize these operative risks for a range of thoracic surgical procedures such as pleurodesis, blebectomy, pleural biopsies, and lung resections 5–11. Studies have demonstrated that compared with GA, in selected patient populations, non-intubated VATS improves patient satisfaction, hospital length of stay, costs, and airway complication rates such as hoarseness and sore throat 4.…”

Retrospective outcomes analysis of 99 consecutive uniportal awake lung biopsies: a real standard of care?

“…The caution needed when referring ILD patients for surgical biopsy derives from a growing concern for the rate of mortality, ranging between 4.2% and 17.5% depending on the stratification of risk factors (10), considering the acute exacerbation of ILD after biopsy as being one of the major causes of mortality. Thus, in recent years, nonintubated VATS (NIVATS) procedures have been carried out in order to avoid the operating and anesthesiological risks of general anesthesia (GA), preserving an acceptable diagnostic and curative outcome, through the avoidance of muscle relaxants and lung injuries from positive pressure ventilation (11,12).…”

Tubeless video-assisted thoracic surgery for pulmonary ground-glass nodules: expert consensus and protocol (Guangzhou)

“…Its aims are to minimize the trauma and pain associated with tube interventions. enhance postoperative recovery, and hopefully make ambulatory VATS a reality (39,40).…”