Nonintubated uniportal thoracoscopic surgery for peripheral lung nodules
Journal
Annals of Thoracic Surgery
Journal Volume
98
Journal Issue
6
Pages
1998-2003
Date Issued
2014
Author(s)
Abstract
Background Uniportal video-assisted thoracoscopic surgery (VATS) has recently been introduced for various thoracic diseases. However, management of peripheral lung nodules by uniportal VATS without tracheal intubation has rarely been attempted. We evaluated the feasibility and safety of nonintubated uniportal VATS for peripheral lung nodules.Methods From January to March 2014, 32 patients with indeterminate peripheral lung nodules underwent uniportal VATS without tracheal intubation using a combination of intercostal nerve block, intrathoracic vagal block, and target-controlled sedation. Computed tomography-guided dye localization was sometimes used to identify small or ground-glass opacity lesions.Results A definite diagnosis was obtained in all 32 patients. A wedge resection was performed in 31 patients and a lobectomy in 1. Conversion to nonintubated multiport VATS was required in 4 patients (13%), in 3 because of primary lung cancer requiring further resection for adequacy of margins and in 1 because of difficulty in identifying a small nodule. Conversion to intubated 1-lung ventilation was required in 1 patient (3%) because of vigorous mediastinal movement. Operative complications developed in 2 patients who had air leaks for more than 3 days postoperatively. The median durations of postoperative chest tube drainage and hospital stay were 1 and 3 days, respectively. Postoperative neuralgia that required occasional use of analgesics occurred in only 1 patient (3%), and 97% of patients were very satisfied or satisfied with the resulting scars at 1 month.Conclusions Nonintubated uniportal VATS is technically feasible and safe for selected patients and is a less invasive alternative in managing indeterminate peripheral lung nodules. ? 2014 The Society of Thoracic Surgeons.
SDGs
Other Subjects
analgesic agent; morphine; paracetamol; adult; aged; air leak; anesthesia induction; arterial carbon dioxide tension; arterial oxygen tension; Article; controlled study; diaphragm movement; drug induced headache; female; follow up; forced expiratory volume; hospitalization; human; intercostal nerve block; intrathoracic vagal block; lobectomy; lung cancer; lung function; lung ventilation; lymph node dissection; major clinical study; male; nausea; neuralgia; nonintubated uniportal thoracoscopic surgery; nonintubated uniportal video assisted thoracoscopic surgery; operation duration; oxygen saturation; pain intensity; peripheral lung lesion; pharmacological blocking; postoperative analgesia; postoperative complication; pressure; primary tumor; scar; sedation; sore throat; space; target controlled sedation; thorax drainage; tumor volume; video assisted thoracoscopic surgery; vomiting; wedge resection; computer assisted tomography; devices; endotracheal intubation; equipment design; Lung Neoplasms; middle aged; multiple pulmonary nodules; radiography; retrospective study; treatment outcome; video assisted thoracoscopic surgery; Adult; Aged; Equipment Design; Female; Follow-Up Studies; Humans; Intubation, Intratracheal; Lung Neoplasms; Male; Middle Aged; Multiple Pulmonary Nodules; Retrospective Studies; Thoracic Surgery, Video-Assisted; Tomography, X-Ray Computed; Treatment Outcome
Publisher
Elsevier USA
Type
journal article