Non-intubated thoracoscopic surgery: initial experience at a single center.

Area of Science:

• Thoracic Surgery
• Minimally-Invasive Procedures
• Anesthesiology

Background:

• Non-intubated thoracoscopic surgery represents an advancement in minimally-invasive thoracic procedures.
• The study reports the initial one-year experience with this surgical approach at a single center, beginning in August 2016.

Purpose of the Study:

• To evaluate the safety and feasibility of non-intubated thoracoscopic surgery.
• To analyze initial outcomes and identify risk factors for conversion to intubation.

Main Methods:

• A consecutive series of patients undergoing thoracoscopic surgery between August 2016 and August 2017 were included, excluding those with specific risk factors.
• Exclusion criteria included high BMI (>30), anticipated difficult airway, extensive pleural adhesions, severe cardiopulmonary dysfunction, persistent cough, excessive airway secretions, high gastric reflux risk, and neurological disorders.

Main Results:

• 115 patients underwent non-intubated thoracoscopic surgery, with 72.2% having lung cancer and 27.8% other conditions.
• The mean anesthesia and operation times were 172.4 and 130 minutes, respectively. Postoperative outcomes included a 3.9-day chest tube duration and a 6.0-day hospital stay.
• A 7.8% conversion rate to intubation occurred due to respiratory issues or adhesions. Sixteen complications (13.9%) were managed successfully, with no postoperative mortality. Old age and high BMI were risk factors for conversion.

Conclusions:

• Non-intubated thoracoscopic surgery is a safe and viable option for carefully selected thoracic surgery patients.
• The study highlights the importance of patient selection to minimize conversion rates and ensure successful outcomes.