AVATS: Awake Video Assisted Thoracic Surgery –extended series report

BACKGROUND: Traditionally, video-assisted thoracic surgery (VATS) is performed under general anesthesia with selective ventilation and endotracheal intubation. Although some sparse data exists on VATS under local anesthesia, most series reserve this technique for pleural-based surgery. Performing VATS under local anesthesia may extend the benefits of this procedure to those unable to tolerate general anesthesia and improve outcomes. METHOD: We have extended this technique to include more complex procedures, with results that surpass traditional open thoracotomies. We analyzed 293 patients who underwent awake video-assisted thoracic surgery (AVATS) from June 2010 to January 2014. RESULTS: Procedures such as pleural biopsies, wedge resections, decortications, and even lobectomies were able to be safely performed using AVATS technique with comparable or better results than VATS under general anesthesia. CONCLUSION: AVATS is a feasible technique with equal or improved outcomes without compromise in safety. Further study may help delineate the role of this technique in the care of the thoracic surgical patient.