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International Society For Minimally Invasive Cardiothoracic Surgery

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MARIA NIZAMI, Chinmay Patvardhan, Aman Coonar, Adam Peryt, Giuseppe Aresu
Royal Papworth Hospital, Cambridge, United Kingdom

Non- intubated Subxiphoid Right Pneumonectomy - Case Report
Nizami Maria, MD
Chinmay Patvardhan, MD
Aman Coonar, MD, FRCS
Adam Peryt, MD
Aresu Giuseppe, MD, PhD
Corresponding author, 22 Stallan Close Trumpington, Cambridge CB29FQ
Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK.
Intercostal VATS approach has shown important benefit when compared to thoracotomy approach however the risk of intercostal nerve injury and consequent acute and chronic pain persists.
Uniportal subxiphoid VATS (SVATS) has been proposed as alternative approach with potential advantages deriving from avoiding the contact with the intercostal neurovascular bundle.
Non intubated thoracic surgery technique has been described as safe alternative to traditional single lung ventilation technique with potential benefits in term of recovery from anaesthesia permitting earlier oral intake and mobilization which may be associated with a reduced length of hospital stay.
Herein we describe, for the first time in literature, a non-intubated subxiphoid VATS pneumonectomy performed in a 74-year-old man who presented a lower lobe tumour squamous cell carcinoma invading the middle lobe and an upper lobe adenocarcinoma.
A 3cm midline vertical incision was made and a right pneumonectomy was performed by dividing and resecting the inferior pulmonary vein, the superior pulmonary vein, the pulmonary artery and finally the main bronchus. Specimen was removed by extending the incision by 2cm. The patient was mobile and pain free from Day 1. There were no anaesthesia-related complications and enhanced recovery was feasible with the patient returned to his baseline performance on Day 3.
Our experience advocates that non-intubated SVATS pneumonectomy is technically feasible and that the benefits related to a minimally invasive surgical technique associated to a minimally invasive ventilatory strategy like the non-intubated ventilation could improve the patient outcome although further studies are required to validate our suggestions.

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