Nonintubated uniportal thoracoscopic segmentectomy for lung cancer

Uniportal thoracoscopic segmentectomy under intubated general anesthesia with one-lung ventilation has recently been introduced for the management of lung cancer patients with small tumors or compromised cardiopulmonary function. However, uniportal thoracoscopic segmentectomy without endotracheal intubation had rarely been performed. Therefore, in this study, we aimed to evaluate the feasibility and safety of this novel technique.

From January 2014 to November 2018, 32 lung cancer patients were treated using nonintubated uniportal thoracoscopic segmentectomy under a combination of target-controlled infusion of propofol, nasal high-flow oxygen therapy, intrathoracic intercostal nerve blockade, and vagal nerve blockade. Sixty-two other lung cancer patients who underwent initial planning nonintubated multiportal thoracoscopic segmentectomy during the same period were included as the control group.

Preoperative dye localization was required in 18 (56.3%) patients of uniportal group. No patients required conversion to tracheal intubation or thoracotomy. Two patients were converted from the one-port to the two-port approach due to severe adhesions in the pleural cavity. The mean durations of anesthetic induction and surgery were 12.7 min and 101.1 min, respectively. Postoperative complications were noted in two patients (2/32, 6.3%) of uniportal group: one had subcutaneous emphysema and the other had prolonged air leaks over 3 days. The median durations of postoperative chest drainage and hospital stay were 1 and 3 days in uniportal group, respectively.

Nonintubated uniportal thoracoscopic segmentectomy is technically feasible and safe for selected patients. It can be an attractive alternative to intubated thoracoscopic segmentectomy for patients with early lung cancer.