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Updated: Jun 29, 2026

Non-Intubated Video-Assisted Thoracoscopic Surgery
05:39

Non-Intubated Video-Assisted Thoracoscopic Surgery

Published on: May 26, 2023

Awake operative videothoracoscopic pulmonary resections.

Eugenio Pompeo1, Tommaso C Mineo

  • 1Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy. pompeo@med.uniroma2.it

Thoracic Surgery Clinics
|October 4, 2008
PubMed
Summary

Awake videothoracoscopic lung resection using thoracic epidural anesthesia is safe and effective, challenging the need for general anesthesia. This approach offers faster recovery and reduced costs for patients undergoing pulmonary procedures.

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Area of Science:

  • Thoracic Surgery
  • Anesthesiology
  • Pulmonary Medicine

Background:

  • Traditional thoracoscopic lung surgery typically requires general anesthesia with one-lung ventilation.
  • Concerns exist regarding surgical difficulty due to lung movement and limited space during awake procedures.
  • Patient acceptance and management of potential anxiety are key considerations for awake thoracic surgery.

Purpose of the Study:

  • To evaluate the safety and feasibility of awake videothoracoscopic lung resection under sole thoracic epidural anesthesia.
  • To assess patient tolerance, satisfaction, and potential complications associated with this technique.
  • To explore the implications of avoiding general anesthesia for recovery, costs, and future surgical indications.

Main Methods:

  • Initial experience with awake videothoracoscopic lung resection performed under thoracic epidural anesthesia.
  • Monitoring for surgical maneuver difficulty, patient anxiety, and adverse events.
  • Assessment of anesthesia satisfaction scores and comparison with non-awake procedures.

Main Results:

  • Procedures were performed safely with no mortality and negligible morbidity.
  • Satisfactory lung collapse was achieved without general anesthesia or one-lung ventilation, facilitating surgical maneuvers.
  • High patient satisfaction scores were reported, with faster recovery, reduced hospital stay, and lower costs.

Conclusions:

  • Awake videothoracoscopic lung resection under thoracic epidural anesthesia is a viable and well-tolerated alternative to general anesthesia.
  • This approach challenges conventional assumptions and may enable earlier resection of pulmonary nodules and expand surgical frontiers.
  • Further research is needed to fully elucidate the physiological impact and optimize its application in thoracic surgery.