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. 2017 Aug;9(8):2587-2598.
doi: 10.21037/jtd.2017.08.96.

Non-intubated single-incision video-assisted thoracic surgery: a two-center cohort of 188 patients

Man-Ling Wang  1 , Carlos Galvez  2 , Jin-Shing Chen  3 , Jose Navarro-Martinez  4 , Sergio Bolufer  2 , Ming-Hui Hung  1 , Hsao-Hsung Hsu  3 , Ya-Jung Cheng  1
Affiliations

Non-intubated single-incision video-assisted thoracic surgery: a two-center cohort of 188 patients

Man-Ling Wang et al. J Thorac Dis. 2017 Aug.

Abstract

Background: Non-intubated single-incision procedures are slowly expanding because of high experience and skill required, and stricter selection criteria. The aim of this study is to present the first retrospective two-center series in Taiwan and Spain.

Methods: We performed a retrospective analysis of 188 patients undergoing non-intubated single-incision video-assisted thoracic surgery (NI-SI-VATS) procedures between July 2013 to November 2015 in two centers in Taiwan (170 patients) and Spain (18 patients) with two different anesthetic methods. Demographic data, clinicopathological features, preoperative tests, and final outcomes were analyzed to compare the outcomes with the two different techniques.

Results: Of the 188 patients, 147 (78%) were women, with a mean body mass index (BMI) of 22.7. Of the 196 specimens, 145 (74%) were malignancies with a mean size of 9.7 mm. Wedge resection was performed in 172 patients (91.4%), anatomical segmentectomy with lymphadenectomy in 8 (4.7%), and lobectomy with lymphadenectomy in 5 (2.6%). Three patients (1.6%) required conversion to orotracheal intubation, while 5 patients (2.7%) required additional ports. Complications appeared in 16 patients (8.5%) with air leak as the most frequent in 7 cases (3.7%). Median chest drainage was 1 day, and median postoperative stay was 3 days. There was neither perioperative death nor postoperative readmission.

Conclusions: Non-intubated single-incision procedures can be feasible and safe in expert hands and experienced teams, even for anatomical resections. Strict selection criteria, skill and experience are mandatory. Comparative cohorts and randomized trials are needed.

Keywords: Thoracoscopy/video-assisted thoracic surgery (VATS); anesthesia; lung cancer surgery.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Non-intubated single-incision VATS in NTUH. (A) Single-incision access during non-intubated procedure in Taiwanese center; (B) end-tidal carbon dioxide detector; (C) ventilation mask for breathing. VATS, video-assisted thoracic surgery; NTUH, National Taiwan University Hospital.
Figure 2
Figure 2
Non-intubated single-incision VATS in HGUA. (A) Single-incision access during non-intubated procedure in Spanish center, with high-flow oxygen nasal prongs; (B) different oxygenation devices used for spontaneous breathing. VATS, video-assisted thoracic surgery; HGUA, Hospital General Universitario Alicante.
Figure 3
Figure 3
Resume of the flowchart of eligible and included patients.
Figure 4
Figure 4
Detailed flowchart: Character on computed tomography and pathological staging.
See this image and copyright information in PMC

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