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Thoracic surgery in the non-intubated spontaneously breathing patient

BACKGROUND: The interest in non-intubated video-assisted thoracic surgery (NIVATS) has risen over the last decade and numerous terms have been used to describe this technique. They all have in common, that the surgical procedure is performed in a spontaneously breathing patient under locoregional an...

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Autores principales: Grott, Matthias, Eichhorn, Martin, Eichhorn, Florian, Schmidt, Werner, Kreuter, Michael, Winter, Hauke
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9793515/
https://www.ncbi.nlm.nih.gov/pubmed/36575519
http://dx.doi.org/10.1186/s12931-022-02250-z
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author Grott, Matthias
Eichhorn, Martin
Eichhorn, Florian
Schmidt, Werner
Kreuter, Michael
Winter, Hauke
author_facet Grott, Matthias
Eichhorn, Martin
Eichhorn, Florian
Schmidt, Werner
Kreuter, Michael
Winter, Hauke
author_sort Grott, Matthias
collection PubMed
description BACKGROUND: The interest in non-intubated video-assisted thoracic surgery (NIVATS) has risen over the last decade and numerous terms have been used to describe this technique. They all have in common, that the surgical procedure is performed in a spontaneously breathing patient under locoregional anaesthesia in combination with intravenous sedation but have also been performed on awake patients without sedation. Evidence has been generated favouring NIVATS compared to one-lung-ventilation under general anaesthesia. MAIN BODY: We want to give an overview of how NIVATS is performed, and which different techniques are possible. We discuss advantages such as shorter length of hospital stay or (relative) contraindications like airway difficulties. Technical aspects, for instance intraoperative handling of the vagus nerve, are considered from a thoracic surgeon’s point of view. Furthermore, special attention is paid to the cohort of patients with interstitial lung diseases, who seem to benefit from NIVATS due to the avoidance of positive pressure ventilation. Whenever a new technique is introduced, it must prove noninferiority to the state of the art. Under this aspect current literature on NIVATS for lung cancer surgery has been reviewed. CONCLUSION: NIVATS technique may safely be applied to minor, moderate, and major thoracic procedures and is appropriate for a selected group of patients, especially in interstitial lung disease. However, prospective studies are urgently needed.
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spelling pubmed-97935152022-12-28 Thoracic surgery in the non-intubated spontaneously breathing patient Grott, Matthias Eichhorn, Martin Eichhorn, Florian Schmidt, Werner Kreuter, Michael Winter, Hauke Respir Res Review BACKGROUND: The interest in non-intubated video-assisted thoracic surgery (NIVATS) has risen over the last decade and numerous terms have been used to describe this technique. They all have in common, that the surgical procedure is performed in a spontaneously breathing patient under locoregional anaesthesia in combination with intravenous sedation but have also been performed on awake patients without sedation. Evidence has been generated favouring NIVATS compared to one-lung-ventilation under general anaesthesia. MAIN BODY: We want to give an overview of how NIVATS is performed, and which different techniques are possible. We discuss advantages such as shorter length of hospital stay or (relative) contraindications like airway difficulties. Technical aspects, for instance intraoperative handling of the vagus nerve, are considered from a thoracic surgeon’s point of view. Furthermore, special attention is paid to the cohort of patients with interstitial lung diseases, who seem to benefit from NIVATS due to the avoidance of positive pressure ventilation. Whenever a new technique is introduced, it must prove noninferiority to the state of the art. Under this aspect current literature on NIVATS for lung cancer surgery has been reviewed. CONCLUSION: NIVATS technique may safely be applied to minor, moderate, and major thoracic procedures and is appropriate for a selected group of patients, especially in interstitial lung disease. However, prospective studies are urgently needed. BioMed Central 2022-12-27 2022 /pmc/articles/PMC9793515/ /pubmed/36575519 http://dx.doi.org/10.1186/s12931-022-02250-z Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Review
Grott, Matthias
Eichhorn, Martin
Eichhorn, Florian
Schmidt, Werner
Kreuter, Michael
Winter, Hauke
Thoracic surgery in the non-intubated spontaneously breathing patient
title Thoracic surgery in the non-intubated spontaneously breathing patient
title_full Thoracic surgery in the non-intubated spontaneously breathing patient
title_fullStr Thoracic surgery in the non-intubated spontaneously breathing patient
title_full_unstemmed Thoracic surgery in the non-intubated spontaneously breathing patient
title_short Thoracic surgery in the non-intubated spontaneously breathing patient
title_sort thoracic surgery in the non-intubated spontaneously breathing patient
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9793515/
https://www.ncbi.nlm.nih.gov/pubmed/36575519
http://dx.doi.org/10.1186/s12931-022-02250-z
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