Nonintubated Videothoracoscopic Operations in Thoracic Oncology
Tommaso C Mineo* and Federico Tacconi
Thoracic Surgery Division, Tor Vergata University, Italy
- *Corresponding Author:
- Dr. Tommaso C Mineo
Thoracic Surgery Division
Tor Vergata University Floor 7th
Viale Oxford 81, 00133, Rome, Italy
Tel: 0039 06 20902880
Fax: 0039 06 20902881
E-mail: [email protected]
Received date: February 25, 2014; Accepted date: March 20, 2014; Published date: March 30, 2014
Citation: Mineo TC and Tacconi F (2014) Nonintubated Videothoracoscopic Operations in Thoracic Oncology. Journal of Surgery [Jurnalul de Chirurgie] 10:6:22-30. doi: 10.7438/1584-9341-10-1-6
Copyright: © 2014 Mineo TC, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.
Background: Despite general anesthesia with one-lung ventilation represents the standard to perform thoracic surgery operations, there is an increasing interest toward alternative methods, such as the use of local or neuroaxial analgesia alone in fully alert or mildly sedated patients. These can be applied to perform a series of videothoracoscopic procedures.
Material and Methods: We reviewed our own institutional experience with this kind of surgery, as well as the most relevant literature findings available on this topic at the usual search websites (PubMed, Scopus, EMBASE). We focused on more recent advances regarding indications, expected advantages, possible pitfalls and implications for future research.
Results: Such an operative modality can be safely and successfully adopted to manage a series of common malignant and non-malignant diseases. In thoracic oncology, it is mainly employed to treat malignant pleural effusion, to remove of pulmonary lesions of any origin, and to perform mediastinal biopsies. Furthermore, even complex procedures such anatomic lung resections and thymectomy are now being performed in this way. When taking into the account just intermediate to major surgeries, reported conversion rates to general anesthesia range between 2.8 and 9%. Despite the lack of randomized controlled trial, there is a general perception that non-intubated videothoracoscopic operation may translate into a lower morbidity rate, better hematosis, and preserved perioperative immunosurveillance. No sufficient data is available as far as long-term outcomes are concerned.
Conclusions: Non-intubated videthoracoscopic operations may be as effective as the equivalent procedures performed with general anesthesia, while providing advantages in terms of cost and postoperative morbidity. This surgical practice should thus be included in the armamentarium of modern era thoracic surgeons, and appropriately designed studies should be undertaken to better define its merits and limitations.