Nonintubated versus intubated "one-stage" preoperative localization and thoracoscopic lung resection

Po-Kuei Hsu; Yi-Ying Lee; Lin-Chi Chuang; Chien-Kun Ting; Mei-Yung Tsou

doi:10.1016/j.xjtc.2021.09.032

Nonintubated versus intubated "one-stage" preoperative localization and thoracoscopic lung resection

JTCVS Tech. 2021 Sep 21:10:517-525. doi: 10.1016/j.xjtc.2021.09.032. eCollection 2021 Dec.

Authors

Po-Kuei Hsu^{1

2}, Yi-Ying Lee¹, Lin-Chi Chuang³, Chien-Kun Ting^{2

4}, Mei-Yung Tsou^{2

4}

Affiliations

¹ Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
² School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
³ Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan.
⁴ Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan.

Abstract

Objective: Nonintubated anesthesia, electromagnetic navigation (EMN)-guided preoperative localization, and uniportal video-assisted thoracic surgery (VATS) are recent innovations in minimally invasive thoracic surgery. This study aimed to explore the feasibility of applying nonintubated anesthesia in a "one-stage" localization and resection workflow.

Methods: Patients who underwent EMN-guided preoperative percutaneous localization with indocyanine green (ICG) and uniportal VATS were included. Perioperative data were compared between patients receiving nonintubated anesthesia and those receiving general anesthesia with endotracheal intubation.

Results: Forty-six patients with a total of 50 nodules were included in the study. Overall, finger palpation could be avoided in 94% of the nodules, whereas fluorescent green signals with a clear border on the pleural surface were noted in 91.3% (21 of 23) of nodules in the nonintubated group and 88.9% (24 of 27) of nodules in the intubated group. Intraoperatively, the nonintubated group had a lower median pH (7.33 [interquartile range (IQR), 7.28-7.40] vs 7.41 [IQR, 7.38-7.44]; P = .003), higher median arterial CO₂ (45.5 [IQR, 41.1-58.7] mm Hg vs 38.4 [IQR, 35.3-40.6] mm Hg; P < .001), and lower arterial oxygen (322 [IQR, 211-433] mm Hg vs 426 [IQR, 355-471] mm Hg; P = .005) levels compared with the intubated group. The nonintubated group also had a shorter median registration time (2.0 [IQR, 1.0-3.0] minutes vs 3.0 [IQR, 2.0-8.0] minutes; P = .008) and total time in the operating room (150 [IQR, 130-175] minutes vs 170 [IQR, 135-203] minutes; P = .035), whereas no between-group differences were seen in localization and operative time. The duration of chest drainage, postoperative complications, pathologic diagnosis, and margins were similar in the 2 groups.

Conclusions: Nonintubated "one-stage" EMN-guided percutaneous ICG localization and uniportal VATS can be an option for selected patients undergoing treatment for small peripheral nodules.

Keywords: BIS, bispectral index; CT, computed tomography; EMN, electromagnetic navigation; ICG, indocyanine green; IQR, interquartile range; OR, operating room; VAL-MAP, virtual-assisted lung mapping; VATS, video-assisted thoracic surgery; electromagnetic navigation; nonintubated anesthesia; uniportal video-assisted thoracic surgery.