International Society For Minimally Invasive Cardiothoracic Surgery

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The Feasibility Of Nonintubated Uniportal Video Assisted Thoracoscopic Surgery
Seha Ahn, Hyun Mi Cho, Yun Ho Kim, Youngkyu Moon, Sook Whan Sung.
Seoul St. Mary’s Hospital, Seoul, Korea, Republic of.

Background: Instead of the conventional VATS pulmonary resection, uniportal (single access) VATS to reduce surgical stress, and VATS under intravenous anesthesia without endotracheal intubation to reduce ventilation-induced lung injury have been adopted by the surgeons in the field of minimally invasive thoracic surgery. We tried to maximize our early postoperative outcomes with the combination of ‘uniportal’ and ‘nonintubated’ VATS pulmonary resection at a single center. Methods: Between January 2017 to November 2017, 59 consecutive patients underwent nonintubated uniportal VATS pulmonary resections. We excluded patients with BMI >30, expected difficult airway, severe cardiopulmonary dysfunction, and clinical stage N2 lung cancer. All the patients were sedated by anesthesiologists and their spontaneous respiration were supported by oxygen, 6 to 9 mL/min via mask, without a double-lumen tube. The bispectral index was also used to monitor the level of sedation. The target BIS value was from 40 to 60. To minimize pain, multi-level intercostal nerve block using local anesthesia agents was performed in all patients, and intrathoracic vagal blockade was performed to minimize patient’s cough reflex in 54 (91.5%). Results: Forty-six (78.0%) procedures were for patients with lung cancers (35 lobectomies, 9 segmentectomies, and 2 wedge resections) and 13 (22.0%) were for patients with pulmonary metastases, benign lung disease, or pleural disease. The mean anesthesia time was 167.2 minutes. The mean operative duration was 126.8 minutes. The mean postoperative chest tube duration was 3.2 days. The mean hospital stay was 6.0 days. There were 3 conversions (5.1%) to intubation due to intraoperative hypoxemia and 1 conversion (1.7%) to multiport VATS due to injury of the segmental artery. There were 10 complications (16.9%) including 2 prolonged air leaks, 2 chylothoraces, 2 pneumonias, 1 pleural effusion, 1 subcutaneous emphysema, 1 pulmonary infarction and 1 postoperative atrial fibrillation. There were no in-hospital mortalities. Conclusions: Nonintubated uniportal VATS in our experience in the first year have shown satisfactory early postoperative outcomes in comparison to other study in the field of minimally invasive thoracic surgeries. In the future, Nonintubated uniportal VATS appears to be a promising and feasible surgical combined approach for appropriately selected patients.


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