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Thorac Cardiovasc Surg 2020; 68(05): 450-456
DOI: 10.1055/s-0039-1696950
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Nonintubated Uniportal Thoracoscopic Thymectomy with Laryngeal Mask

Zhengcheng Liu 
1   Department of Thoracic Surgery, Nanjing Chest Hospital, Nanjing, China
,
Rusong Yang
1   Department of Thoracic Surgery, Nanjing Chest Hospital, Nanjing, China
,
Yang Sun
2   Department of Anaesthesia, Nanjing Chest Hospital, Nanjing, China
› Author Affiliations Funding No funding was included in this work.
Further Information

Publication History

23 March 2019

31 July 2019

Publication Date:
15 September 2019 (online)

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Abstract

Objective To investigate whether laryngeal mask anesthesia had more favorable postoperative outcomes than double-lumen tube intubation anesthesia in uniportal thoracoscopic thymectomy.

Methods Data were collected retrospectively from December 2013 to December 2017. A total of 96 patients with anterior mediastinum mass underwent nonintubated uniportal video-assisted thoracoscopic thymectomy with laryngeal mask, and 129 patients underwent intubated uniportal video-assisted thoracoscopic thymectomy. A single incision of ∼3 cm was made in an intercostal space along the anterior axillary line. Perioperative outcomes between nonintubated uniportal video-assisted thoracoscopic surgery (NU-VATS) and intubated uniportal video-assisted thoracoscopic surgery (IU-VATS) were compared.

Results In both groups, incision size was kept to a minimum, with a median of 3 cm, and complete thymectomy was performed in all patients. Mean operative time was 61 minutes. The mean lowest SpO2 during operation was not significantly different. However, the mean peak end-tidal carbon dioxide in the NU-VATS group was higher than in the IU-VATS group. Mean chest tube duration in NU-VATS group was 1.9 days. Mean postoperative hospital stay was 2.5 days, with a range of 1 to 4 days. Time to oral fluid intake in the NU-VATS group was significantly less than in the IU-VATS group (p < 0.01). Several complications were significantly less in the NU-VATS group than in the IU-VATS group, including sore throat, nausea, irritable cough, and urinary retention.

Conclusion Compared with intubated approach, nonintubated uniportal thoracoscopic thymectomy with laryngeal mask is feasible for anterior mediastinum lesion, and patients recovered faster with less complications.

Keywords

nonintubated - uniportal - VATS - thymectomy
 

  • References

  • 1 Jurado J, Javidfar J, Newmark A. , et al. Minimally invasive thymectomy and open thymectomy: outcome analysis of 263 patients. Ann Thorac Surg 2012; 94 (03) 974-981 , discussion 981–982
    CrossrefPubMedSearch in Google Scholar
  • 2 Burt BM, Yao X, Shrager J. , et al. Determinants of complete resection of thymoma by minimally invasive and open thymectomy: analysis of an international registry. J Thorac Oncol 2017; 12 (01) 129-136
    CrossrefPubMedSearch in Google Scholar
  • 3 Liu J, Cui F, Li S. , et al. Nonintubated video-assisted thoracoscopic surgery under epidural anesthesia compared with conventional anesthetic option: a randomized control study. Surg Innov 2015; 22 (02) 123-130
    CrossrefPubMedSearch in Google Scholar
  • 4 Friedant AJ, Handorf EA, Su S, Scott WJ. Minimally invasive versus open thymectomy for thymic malignancies: systematic review and meta-analysis. J Thorac Oncol 2016; 11 (01) 30-38
    CrossrefPubMedSearch in Google Scholar
  • 5 Ye B, Tantai JC, Ge XX. , et al. Surgical techniques for early-stage thymoma: video-assisted thoracoscopic thymectomy versus transsternal thymectomy. J Thorac Cardiovasc Surg 2014; 147 (05) 1599-1603
    CrossrefPubMedSearch in Google Scholar
  • 6 Fadayomi AB, Iniguez CEB, Chowdhury R. , et al. Propensity score adjusted comparison of minimally invasive versus open thymectomy in the management of early stage thymoma. Thorac Cardiovasc Surg 2018; 66 (04) 352-358
    Thieme ConnectPubMedSearch in Google Scholar
  • 7 Chen JS, Cheng YJ, Hung MH, Tseng YD, Chen KC, Lee YC. Nonintubated thoracoscopic lobectomy for lung cancer. Ann Surg 2011; 254 (06) 1038-1043
    CrossrefPubMedSearch in Google Scholar
  • 8 Wu CY, Chen JS, Lin YS. , et al. Feasibility and safety of nonintubated thoracoscopic lobectomy for geriatric lung cancer patients. Ann Thorac Surg 2013; 95 (02) 405-411
    CrossrefPubMedSearch in Google Scholar
  • 9 Wilson M, Stacey S, Anwar S. Intubated versus nonintubated general anesthesia for video-assisted thoracoscopic surgery - a case control study: a response. J Cardiothorac Vasc Anesth 2018; 32 (01) e32-e33
    CrossrefPubMedSearch in Google Scholar
  • 10 Pompeo E, Mineo D, Rogliani P, Sabato AF, Mineo TC. Feasibility and results of awake thoracoscopic resection of solitary pulmonary nodules. Ann Thorac Surg 2004; 78 (05) 1761-1768
    CrossrefPubMedSearch in Google Scholar
  • 11 Jiang L, Depypere L, Rocco G. , et al; AME Thoracic Surgery Collaborative Group. Spontaneous ventilation thoracoscopic thymectomy without muscle relaxant for myasthenia gravis: comparison with “standard” thoracoscopic thymectomy. J Thorac Cardiovasc Surg 2018; 155 (04) 1882-1889.e3
    CrossrefPubMedSearch in Google Scholar
  • 12 Ahmed Z, Samad K, Ullah H. Role of intercostal nerve block in reducing postoperative pain following video-assisted thoracoscopy: a randomized controlled trial. Saudi J Anaesth 2017; 11 (01) 54-57
    CrossrefPubMedSearch in Google Scholar
  • 13 Hsieh MJ, Wang KC, Liu HP. , et al. Management of acute postoperative pain with continuous intercostal nerve block after single port video-assisted thoracoscopic anatomic resection. J Thorac Dis 2016; 8 (12) 3563-3571
    CrossrefPubMedSearch in Google Scholar
  • 14 Liu Z, Yang R, Shao F. Comparison of postoperative pain and recovery between single-port and two-port thoracoscopic lobectomy for lung cancer. Thorac Cardiovasc Surg 2019; 67 (02) 142-146
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 Hung MH, Hsu HH, Cheng YJ, Chen JS. Nonintubated thoracoscopic surgery: state of the art and future directions. J Thorac Dis 2014; 6 (01) 2-9
    PubMedSearch in Google Scholar
  • 16 Chen KC, Cheng YJ, Hung MH, Tseng YD, Chen JS. Nonintubated thoracoscopic lung resection: a 3-year experience with 285 cases in a single institution. J Thorac Dis 2012; 4 (04) 347-351
    PubMedSearch in Google Scholar