New tubeless video-assisted thoracoscopic surgery for small pulmonary nodules

• Published in: European journal of cardio-thoracic surgery 2017-04, Vol.51 (4), p.689-693
• Main Authors: Li, Shuben, Jiang, Long, Ang, Keng-Leong, Chen, Hanzhang, Dong, Qinglong, Yang, Hanyu, Li, Jingpei, He, Jianxing
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anesthesia, Intravenous - methods; Chest Tubes; Feasibility Studies; Female; Humans; Intubation, Intratracheal; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Male; Middle Aged; Pain Measurement - methods; Pain, Postoperative; Pneumonectomy - methods; Postoperative Care - methods; Solitary Pulmonary Nodule - pathology; Solitary Pulmonary Nodule - surgery; Thoracic Surgery, Video-Assisted - methods; Urinary Catheterization
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezw364

Abstract OBJECTIVE: Problems associated with intubation, chest drainage and urinary catheterization can have a negative impact on patient's recovery after thoracic surgery. We therefore evaluated the feasibility of a new tubeless (spontaneous ventilation without tracheal intubation, urinary catheterization, and no post-operative chest drain placement) approach to perform video-assisted thoracoscopic surgery (VATS) for small pulmonary nodules (SPN) less than 2cm in diameter. METHODS: From 1 January 2012 to 31 December 2014, 34 patients with SPNs were treated using tubeless VATS in our centre. To be eligible for this approach, the patient must have a body mass index (BMI) of less than 25; ASA grade of II or less; no history of prostate or renal disease and no parenchymal air leak at the end of surgery. All operations were performed via an anterior uniportal VATS under spontaneous ventilation without tracheal intubation. RESULTS: All patients [29 male:5 females; average age: 58 ± 19 years old] completed their operation under spontaneous ventilation, without conversion to endotracheal intubation. There was good operative exposure and definite diagnosis was obtained in all patients. The anaesthesia and operating time were 23 ± 3 min and 43 ± 10 min, respectively. No major intra-operative or post-operative complications were seen. Patients recovered from their anaesthesia (fully awake) within a mean time of 18 ± 3 min after surgery, and were eating 42 normally on an average of 5 ± 1 h post-operatively. No patients had pain on deep breathing or coughing (Bruggemann Comfort Score