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. 2018 Jun;10(6):3490-3498.
doi: 10.21037/jtd.2018.05.147.

Non-intubated thoracoscopic surgery: initial experience at a single center

Affiliations

Non-intubated thoracoscopic surgery: initial experience at a single center

Youngkyu Moon et al. J Thorac Dis. 2018 Jun.

Abstract

Background: Non-intubated thoracoscopic surgery is an evolving form of minimally-invasive thoracic surgery. We commenced performing non-intubated thoracoscopic surgery at our center in August 2016. We would like to report our initial experience, over a period of 1 year, with this procedure.

Methods: From August 2016 to August 2017, non-intubated thoracoscopic surgery was performed in a series of consecutive patients who underwent thoracoscopic surgery in those who did not meet any of the following exclusion criteria: body mass index (BMI) >30, expected difficult airway, expected extensive pleural adhesion, severe cardiopulmonary dysfunction, persistent cough or excessive airway secretion, high risk of gastric reflux, and underlying neurological disorder.

Results: A total of 115 consecutive patients underwent non-intubated thoracoscopic surgery. Of these, 83 (72.2%) of patients had lung cancers that had undergone pulmonary resection and the other 32 (27.8%) patients were diagnosed with pulmonary metastasis, benign lung diseases, thymic tumor or other conditions. The mean time of anesthesia was 172.4 min and time of operation was 130 min. The mean postoperative chest tube duration was 3.9 days and time of hospital stay was 6.0 days. There were 9 conversions (7.8%) to intubation, due to increased respiratory movement with intraoperative hypoxemia or severe pleural adhesion. There were 16 complications (13.9%) following surgery, but all of these were successfully managed during the period of hospital stay. There was no postoperative mortality. In multivariate analysis, old age and high BMI were significant risk factors for conversion to intubation (hazard ratio =1.122, P=0.038; hazard ratio =1.408, P=0.042, respectively).

Conclusions: Non-intubated thoracoscopic surgery can safely be performed in selected patients.

Keywords: Non-intubation; surgery; thoracoscopy.

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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
Thoracoscopic-guided intercostal nerve block. (A) Thoracoscopic instrument for nerve block; (B) intercostal nerve block into the space beneath the lower margin of each rib from 3rd to 9th.
Figure 2
Figure 2
Thoracoscopic-guided vagus nerve block. (A) Right vagus nerve block to right paratracheal area; (B) left vagus nerve block to left subaortic area.

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