Bedetti Benedetta, Patrini Davide, Bertolaccini Luca, Crisci Roberto, Solli Piergiorgio, Schmidt Joachim, Scarci Marco
Department of Thoracic Surgery, Malteser Hospital, Bonn, Germany.
Department of Thoracic Surgery, University College of London Hospitals, London, UK.
J Vis Surg. 2018 Jan 18;4:18. doi: 10.21037/jovs.2017.12.09. eCollection 2018.
Uniportal video-assisted thoracoscopic surgery (VATS) is the most advanced evolution of the minimally invasive technique, which allows often the possibility to include patients in enhanced recovery programs in order to optimize the therapeutic pathway, shorten the length of stay and reduce hospital costs. Non-intubated VATS procedures allow the performance of surgeries with minimal sedation without general anesthesia, maintaining throughout the operation spontaneous breathing. The principle is to create an iatrogenic spontaneous pneumothorax, which can provide a good lung isolation without the need of a double lumen tube. A survey between the members of the European Society of Thoracic Surgery (ESTS) showed that non-intubated VATS procedures are already performed by a large number of ESTS members for minor procedures. With the publication of new data and the spreading of uniportal VATS in many centers worldwide in the last decades, the application of the non-intubated technique in major procedure like anatomic resections is expected to grow. This technique can potentially be beneficial for high-risk patients but also could be used for the routine procedures as well, but more data are needed to establish the real benefit for these groups of patients.
单孔电视辅助胸腔镜手术（VATS）是微创技术的最先进发展形式，它通常使患者有可能纳入加速康复计划，以优化治疗路径、缩短住院时间并降低医院成本。非插管VATS手术允许在极少镇静的情况下进行手术，无需全身麻醉，在整个手术过程中保持自主呼吸。其原理是制造医源性自发性气胸，无需双腔气管导管即可实现良好的肺隔离。欧洲胸外科医师协会（ESTS）成员之间的一项调查显示，大量ESTS成员已在进行小手术时采用非插管VATS手术。随着新数据的发表以及过去几十年单孔VATS在全球许多中心的推广，非插管技术在诸如解剖性切除等大手术中的应用有望增加。该技术可能对高危患者有益，也可用于常规手术，但需要更多数据来确定对这些患者群体的实际益处。
