Literature review: non-intubated (tubeless) VATS for lung volume reduction surgery

Abstract

The non-intubated video-assisted thoracoscopic surgery (NI-VATS) is developed from traditional video-assisted thoracoscopic surgery (VATS). In NI-VATS, deep anesthesia is avoided, and a face or laryngeal is used instead of ordinary tracheal intubation. Patients usually have fewer complaints of postoperative discomfort and recover faster by this method. Since the first report of NI-VATS wedge resection, surgical teams from all over the world have enlarged the range of non-intubation to almost all kinds of VATS treatments, such as mediastinal tumor resection (1), carinal reconstruction (2), and lobectomy (3). Lung volume reduction surgery (LVRS) is taken as an interventional therapy for severe emphysema caused by chronic obstructive pulmonary disease (COPD), smoking, or other factors. In LVRS, the damaged emphysematous upper lobe tissue is resected, in which the expiratory airway collapses, gas traps severely, and the alveolus is over-inflated. Then the remaining lung expands, and the patient’s symptoms like shortness of breath or dyspnea may improve (4,5). Objective: To describe the reproducible surgical and anesthesia techniques of lung volume reduction surgery (LVRS) under non-intubation. In addition, the advantages of modified non-intubated unilateral LVRS are also introduced in this article. Background: The perioperative complications and unsatisfied mortality of the typical LVRS under general anesthesia hinder the popularity of the surgery. In recent years, the concept of non-intubation has been introduced to LVRS. However, the reports and researches in this field are not so common. Methods: We searched current literature related to LVRS and non-intubated LVRS of recent 20 years in PubMed and compared different resection ranges and methods of LVRS under non-intubation. Conclusions: Our group reviewed the current papers in this field and found that the poor lung quality (and cardiac function in some cases) of the target patient is not the absolute contradiction to adopting the non-intubation anesthesia technique in LVRS. On the contrary, the non-intubated LVRS may be even safer and bring more benefits than the traditional operation method among selected patients. Furthermore, the modified non-intubated unilateral LVRS can reduce perioperative complications by comparing to the traditional bilateral LVRS. The LVRS on the opposite side is unnecessary if no significant progression is found by regular follow-up. In summary, the surgical team can make an attempt to non-intubation in LVRS after thorough evaluation.