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Updated: Oct 18, 2026

Non-Intubated Video-Assisted Thoracoscopic Surgery
Published on: May 26, 2023
Non-intubated video-assisted thoracoscopic McKeown oesophagectomy using i-gel™ and continuous pressure support
Megha Ranjan1, Prashant Sirohiya2, Prateek Maurya2
1Department of Onco-Anaesthesia and Palliative Medicine, Dr. BRA IRCH, AIIMS, New Delhi, India.
Abstract:
Non-intubated video-assisted thoracoscopic surgery (NIVATS) minimises airway trauma and ventilator-induced lung injury, yet its application in complex, multi-phase McKeown oesophagectomy is seldom reported. A 32-year-old female (40 kg, 140 cm and body mass index: 20.4 kg/m 2 ) presented for McKeown minimally invasive oesophagectomy following neoadjuvant chemoradiotherapy. We employed a 'less invasive anaesthesia' strategy combining T9-T10 thoracic epidural analgesia with Bispectral Index-guided target-controlled propofol infusion. Continuous pressure support ventilation (16 cmH 2 O above a positive end-expiratory pressure of 5 cmH 2 O) with preserved spontaneous breathing was maintained via a size 3 i-gel™ throughout surgery; neuromuscular blockade and controlled mechanical ventilation were not used at any stage. Surgical exposure was optimised via right-sided capnothorax. The resulting permissive hypercapnia was haemodynamically well-tolerated. Recovery was uneventful, and the airway device was removed after protective airway reflexes had returned. She was discharged from the hospital on post-operative day 6 without any complications. NIVATS for McKeown oesophagectomy may be feasible in carefully selected patients.
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