Awake uniportal VATS sublobar lung resections in high-comorbidity patients: Single-center early post-operative outcomes

Giovanni Mugnaini; Domenico Viggiano; Paolo Fontanari; Rossella Forzini; Luca Voltolini; Alessandro Gonfiotti

doi:10.3389/fsurg.2023.1120414

Awake uniportal VATS sublobar lung resections in high-comorbidity patients: Single-center early post-operative outcomes

Front Surg. 2023 Feb 17:10:1120414. doi: 10.3389/fsurg.2023.1120414. eCollection 2023.

Authors

Giovanni Mugnaini¹, Domenico Viggiano¹, Paolo Fontanari², Rossella Forzini², Luca Voltolini^{1

3}, Alessandro Gonfiotti^{1

3}

Affiliations

¹ Thoracic Surgery Unit, Careggi University Hospital, Florence, Italy.
² Department of Anhestesiology and Reanimation, Careggi University Hospital, Florence, Italy.
³ Department of Experimental and Clinical Medicine, University of Florence, Italy.

Abstract

Introduction: Awake minimally invasive Uniportal Video Assisted Thoracic Surgery (U-VATS) represents the last challenge in thoracic surgery that could change the future scenario for high comorbidity patients with early-stage non-small cell lung cancer (NSCLC). We report a single center preliminary experience of awake thoracoscopic uni-portal anatomic and non-anatomic sub-lobar resections in this setting.

Methods: We retrospectively analyzed data collected on a prospective database of patients undergoing U-VATS awake sub-lobar lung resections for NSCLC between September 2021 and September 2022. Inclusion criteria were clinical stage I disease; contraindication to standard lobectomy due to high respiratory function impairment; general anesthesia considered at high risk based on the American Society of Anesthesiologist score and on the Charlson Comorbidity Index. All patients underwent a standardized awake non-intubated anesthesia protocol approved by our institutional board.

Results: They were n = 10 patients: n = 8 wedge resections; n = 2 segmentectomies. We had n = 1 (10%) conversion to standard general anesthesia and n = 1 laryngeal mask support but maintaining spontaneous breathing. N = 5 patients (50%) needed an Intensive Care Unit recovery (mean time = 17.20 h). Mean chest tube duration and Hospital stay were 2.0 and 3.5 days respectively. We did not register 30- days postoperative mortality.

Conclusion: Awake thoracic surgery is a feasible technique, and it could be performed also in high comorbidities' patients without a high rate of complications and allows to operate patients that so far were considered borderline for surgery.

Keywords: awake thoracic surgery; minimally invasive thoracic surgery; non-intubated thoracic surgery; spontaneous breathing; sublobar lung resections; uniportal video assisted thoracic surgery.