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Five Hundred Seventy-Six Cases of Video-Assisted Thoracic Surgery Using Local Anesthesia and Sedation: Lessons
1Department of Surgery, Sinai Hospital and Northwest Hospital, Baltimore, MD.
Journal of the American College of Surgeons
|October 18, 2017
Summary
Local anesthesia and sedation enable safe and effective video-assisted thoracic surgery (VATS) for many patients, avoiding general anesthesia and intubation. This approach offers a viable alternative for thoracic procedures, improving patient outcomes.
Area of Science:
- Thoracic Surgery
- Anesthesiology
- Minimally Invasive Surgery
Background:
- General anesthesia and endotracheal intubation are often unnecessary for video-assisted thoracic surgery (VATS).
- The practice of using local anesthesia and sedation for thoracic procedures was initiated over two decades ago.
- This technique has been applied to various conditions including pleural, pericardial, and lung diseases.
Purpose of the Study:
- To evaluate the safety and efficacy of video-assisted thoracic surgery (VATS) performed under local anesthesia and sedation.
- To analyze the outcomes of a large cohort of patients undergoing VATS with this anesthetic approach.
- To provide guidance for thoracic surgeons and anesthesiologists interested in adopting this technique.
Main Methods:
- Retrospective review of patient records from two health systems (Geisinger Health System and Lifebridge Health System) between June 2002 and March 2017.
- Inclusion criteria allowed all patients undergoing VATS with local anesthesia and sedation, regardless of age, BMI, or comorbidities.
- Patients did not receive endotracheal intubation, laryngeal mask airway, or advanced regional analgesia; all maintained spontaneous respiration.
Main Results:
- 529 patients underwent 576 VATS procedures under local anesthesia and sedation, with ages ranging from 21 to 104 years.
- Procedures included pleural biopsy-drainage, empyema drainage, lung biopsy, hemothorax evacuation, and pericardial window creation.
- No patient required intubation or conversion to thoracotomy, with a low complication rate of 2% (12 patients) and no operative deaths.
Conclusions:
- Video-assisted thoracic surgery (VATS) under local anesthesia and sedation is a safe and effective option for a wide range of thoracic conditions.
- The findings demonstrate the feasibility of this approach, challenging the routine use of general anesthesia.
- Lessons learned from this extensive patient series can facilitate the adoption of this minimally invasive technique by other surgical teams.