Derdiyok Onur, Temel Uğur
Department of Thoracic Surgery, Unit of Thoracic Surgery, Sisli Hamidiye Etfal Research and Training Hospital, University of Health Sciences, Istanbul, Turkey.
Department of Thoracic Surgery, Şişli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey.
J Minim Access Surg. 2025 Apr 1;21(2):189-194. doi: 10.4103/jmas.jmas_124_24. Epub 2024 Oct 9.
Awake video-assisted thoracoscopic surgery (VATS) helps to avoid the adverse effects of general anaesthesia (GA) with single-lung ventilation. Its usage in anatomic and non-anatomic pulmonary resections has spread worldwide, and it is mostly performed under thoracic epidural analgesia (TEA). We herein report our surgical experience with awake VATS non-anatomical resections under the thoracic paravertebral block (TPB).
This retrospective, single-centred study reviewed patients undergoing awake VATS non-anatomical pulmonary resection under TPB, who voluntarily accepted awake VATS despite being suitable for GA and were found unsuitable for GA based on pre-operative assessment results. Demographic, pre-, per- and post-operative data were collected, analysed and compared with the literature data.
Twenty-four patients (16 patients with normal pre-operative assessment results and 8 patients having high risk for GA) were selected. Fourteen bullectomies for recurrent spontaneous pneumothorax and 10 wedge resections (nine for metastasectomy and one for lung biopsy) were performed. Global in-operating room time was 77 ± 31 min. The morbidity rate was 20.8% ( n = 5), including prolonged air leak in three and pneumonia in two patients. The mean duration of the chest tube was 1.9 ± 1.5 days and mean duration of hospital stay was 3.5 ± 2.1 days. There was no in-hospital mortality. Our results were mostly similar to the literature data.
Non-anatomical lung resections by VATS can be performed easily and safely under TPB in awake patients. Although the perioperative and post-operative outcomes are not superior to other anaesthesia approaches, preferring TPB may help to avoid the serious potential complications of TEA.
清醒电视辅助胸腔镜手术（VATS）有助于避免全身麻醉（GA）和单肺通气带来的不良反应。其在解剖性和非解剖性肺切除术中的应用已在全球范围内推广，且大多在胸段硬膜外镇痛（TEA）下进行。我们在此报告我们在胸段椎旁阻滞（TPB）下进行清醒VATS非解剖性切除术的手术经验。
这项回顾性单中心研究对在TPB下接受清醒VATS非解剖性肺切除术的患者进行了评估，这些患者尽管适合GA，但自愿接受清醒VATS，且根据术前评估结果被认为不适合GA。收集了人口统计学、术前、术中和术后的数据，并与文献数据进行了分析和比较。
选择了24例患者（16例术前评估结果正常，8例有GA高风险）。进行了14例复发性自发性气胸的肺大疱切除术和10例楔形切除术（9例用于转移瘤切除术，1例用于肺活检）。手术总时长为77±31分钟。发病率为20.8%（n = 5），包括3例持续性漏气和2例肺炎。胸管平均留置时间为1.9±1.5天，平均住院时间为3.5±2.1天。无院内死亡。我们的结果与文献数据大多相似。
在清醒患者中，通过TPB可轻松、安全地进行VATS非解剖性肺切除术。虽然围手术期和术后结果并不优于其他麻醉方法，但选择TPB可能有助于避免TEA的严重潜在并发症。
