Tubeless major pulmonary resections.

Area of Science:

• Thoracic Surgery
• Minimally Invasive Procedures
• Anesthesiology

Background:

• Minimally invasive thoracic surgery aims to reduce patient trauma.
• While uniportal VATS improves outcomes, further enhancements in patient comfort are needed.
• The 'tubeless' approach represents a novel advancement in thoracic surgical care.

Purpose of the Study:

• To introduce and evaluate the 'tubeless' non-intubated VATS concept.
• To explore its feasibility and safety in selected patients.
• To highlight its potential for improved patient recovery and reduced perioperative morbidity.

Main Methods:

• Non-intubated video-assisted thoracic surgery (VATS) under loco-regional anesthesia.
• Avoidance of double-lumen intubation, central lines, epidural, urinary catheters, and chest tubes.
• Application in selected patients undergoing thoracic procedures, including major lung resections.

Main Results:

• Experienced teams have demonstrated the feasibility and safety of non-intubated major lung resections.
• Concerns regarding spontaneous breathing, oxygenation, and cough reflex have been addressed through specialized techniques.
• The tubeless approach facilitates faster patient recovery and minimizes trauma.

Conclusions:

• Tubeless thoracic surgery is an evolving technique that minimizes patient invasiveness.
• It challenges previous exclusion criteria and expands indications for major thoracic surgeries.
• This approach promotes better intraoperative status and significantly reduces recovery needs.