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Review
. 2018 Dec;10(12):6987-6992.
doi: 10.21037/jtd.2018.11.90.

Anesthesia and enhanced recovery in subxiphoid video-assisted thoracoscopic surgery

Zhigang Chen  1 , Jason M Ali  2 , Huan Xu  1 , Lei Jiang  1 , Giuseppe Aresu  2
Affiliations
Review

Anesthesia and enhanced recovery in subxiphoid video-assisted thoracoscopic surgery

Zhigang Chen et al. J Thorac Dis. 2018 Dec.

Abstract

Subxiphoid video-assisted thoracoscopic surgery (VATS) is a surgical approach in minimally invasive thoracic surgery that aims to aid enhanced recovery by reducing postoperative pain by avoiding instrumentation of the intercostal spaces. Access through a subxiphoid port presents challenges for both the surgeon and anaesthetist. Particularly for left sided procedures, the heart can be compressed resulting in arrhythmia and haemodynamic compromise. The anaesthetic team play an important role in ensuring the success of subxiphoid VATS procedures. The key is continuous and comprehensive monitoring for circulatory disturbance and arrhythmia intraoperatively. Should arrhythmia develop it is important that it is managed rapidly and effectively in such a manner to minimize haemodynamic disturbance. In this article, important considerations for anaesthesia in subxiphoid VATS procedures is presented and solutions presented.

Keywords: Anaesthesia; enhanced recovery; subxiphoid; subxiphoid VATS (SVATS); video-assisted thoracoscopic surgery (VATS).

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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
Subxiphoid access port for surgery with a patient in the right lateral decubitus position.
Figure 2
Figure 2
Optimal patient positioning with the patient tilted away from the lateral decubitus position which can be achieved by either tilting the operating table (A), or tilting the patient (B).
Figure 3
Figure 3
Example arrhythmias experienced during subxiphoid VATS procedures. (A) Atrial ectopy, (B) ventricular ectopy, (C,D) ventricular ectopy leading to escape rhythms, (E) mixture of atrial and ventricular ectopy, (F) atrial fibrillation and (G) ventricular tachycardia. VATS, video-assisted thoracoscopic surgery.
See this image and copyright information in PMC

References

    1. Demmy TL, Nwogu C. Is video-assisted thoracic surgery lobectomy better? Quality of life considerations. Ann Thorac Surg 2008;85:S719-28. 10.1016/j.athoracsur.2007.09.056 - DOI - PubMed
    1. Demmy TL, Curtis JJ. Minimally invasive lobectomy directed toward frail and high-risk patients: a case-control study. Ann Thorac Surg 1999;68:194-200. 10.1016/S0003-4975(99)00467-1 - DOI - PubMed
    1. Sugiura H, Morikawa T, Kaji M, et al. Long-term benefits for the quality of life after video-assisted thoracoscopic lobectomy in patients with lung cancer. Surg Laparosc Endosc Percutan Tech 1999;9:403-8. 10.1097/00129689-199912000-00007 - DOI - PubMed
    1. Wang BY, Chang YC, Chang YC, et al. Thoracoscopic surgery via a single-incision subxiphoid approach is associated with less postoperative pain than single-incision transthoracic or three-incision transthoracic approaches for spontaneous pneumothorax. J Thorac Dis 2016;8:S272-8. - PMC - PubMed
    1. Li L, Tian H, Yue W, et al. Subxiphoid vs intercostal single-incision video-assisted thoracoscopic surgery for spontaneous pneumothorax: A randomised controlled trial. Int J Surg 2016;30:99-103. 10.1016/j.ijsu.2016.04.035 - DOI - PubMed