Nonintubated Subxiphoid Bilateral Redo Lung Volume Reduction Surgery

Area of Science:

• Thoracic Surgery
• Pulmonology
• Anesthesiology

Background:

• Lung volume reduction surgery (LVRS) is a treatment for severe emphysema.
• Redo LVRS presents surgical challenges, particularly in patients with prior bilateral procedures.
• Nonintubated anesthesia protocols are emerging to reduce perioperative complications.

Observation:

• A patient with a history of bilateral LVRS 19 years prior underwent a redo procedure.
• The surgery was performed thoracoscopically via a single subxiphoid access.
• The patient did not require intubation during the procedure.

Findings:

• The nonintubated, bilateral thoracoscopic redo LVRS was successfully completed uneventfully.
• The patient was discharged on postoperative day 2.
• Significant improvements in respiratory function and exercise tolerance were observed at 3 months postoperatively.

Implications:

• This single subxiphoid access approach offers a minimally invasive option for bilateral redo LVRS.
• The technique combines potential benefits of subxiphoid incision, nonintercostal drains, and nonintubated anesthesia.
• This novel approach may enhance recovery and outcomes for selected LVRS patients.