Non-intubated thoracic surgery is not a new idea or concept. It was developed early in the 20th century and used successfully for many years for even the most complex thoracic cases until the development of double lumen intubation in the 1950s made the use of single-lung ventilation possible. Multiple studies have reported successful thoracic surgery outcomes in Non-intubated patients, thus eliminating the majority of risks related to general anesthesia, as well as uni-lung ventilation via mechanical ventilation and intubation. Non-Intubated VATS procedures have demonstrated a high rate of success in treating those at the very margins of the thoracic surgery patient population (the extreme elderly, patients with advanced respiratory disease, or other serious medical co-morbidities) who are often deemed inoperable using current techniques. Here we present our initial experiences and results with Non-Intubated VATS procedures.
Key words: Non-Intubated, VATS
Materials and methods
Between November 2015. and March 2016. seven patients were surgically treated by performing Non-intubated VATS. There were four males and three female patients with an average age of 41 years (24-59). Prior to placing patients under analgesia and sedation (fentanylum and propofolum) a regional paravetebral analgesia was performed under ultrasonic guidance. Breathing was spontaneous and only a facial mask was positioned. Lung collapse was facilitated by iatrogeneous pneumothorax when the first VAST port was created.
There were two wedge resections due to colorectal cancer metasteses, one lingular resection due to colorectal cancer metastasis, two pleural biopsies and two apical resections with mechanical pleural abrasions due to spontaneous pneumothorax. Average operating time was 39 minutes (15-65). There were no perioperative complications. Average length of drainage was 3.1 days (1-5) and hospital stay was 4,2 days (2-6).
Non-intubated VATS procedures are beneficial, and more challenging for anesthesiologists than surgeons. Cooperation between surgeons and anesthesiologist is necessary to avoid the complications during procedures.
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