Video-assisted thoracic surgery utilizing local anesthesia and sedation: 384 consecutive cases

Area of Science:

• Thoracic Surgery
• Anesthesiology
• Minimally Invasive Surgery

Background:

• Video-assisted thoracic surgery (VATS) typically requires general anesthesia and endotracheal intubation.
• General anesthesia carries inherent risks, and not all thoracic procedures necessitate such intensive anesthetic management.
• Alternative anesthetic techniques for VATS warrant investigation to improve patient safety and expand procedural options.

Purpose of the Study:

• To evaluate the safety and efficacy of VATS performed under local anesthesia and sedation with spontaneous ventilation.
• To determine the feasibility of this approach across a range of thoracic surgical procedures.
• To assess complication rates and patient outcomes in this cohort.

Main Methods:

• Retrospective review of medical records for patients undergoing VATS with local anesthesia and sedation between June 2002 and June 2009.
• All procedures were performed by attending surgeons or supervised residents.
• No patients were excluded based on age or comorbidities; no endotracheal intubation or advanced regional analgesia was used.

Main Results:

• 384 VATS procedures were performed on 353 patients (age 21-100 years) for various indications including pleural procedures, empyema drainage, and biopsies.
• No patient required intubation or conversion to open thoracotomy.
• Ten complications were observed, with no operative deaths; 30-day mortality was attributed to underlying conditions or overanticoagulation.

Conclusions:

• VATS utilizing local anesthesia and sedation is a well-tolerated, safe, and effective technique.
• This approach is suitable for an expanding range of thoracic surgical indications.
• It offers a valuable alternative to general anesthesia, potentially reducing risks and improving patient recovery.