Entübe olmayan tek cerrahlı ve tek portlu video yardımlı torasik cerrahi: İkinci basamak bir hastane ilk deneyimlerinin retrospektif değerlendirmesi

Abstract

Aim: Performing thoracic surgical procedures in a secondary care hospital is often challenging due to shortness of staff and lack of technical opportunities. Non-intubated thoracic surgery can be performed in patients with high risk for general anesthesia. Our aim is to share our non-intubated video-thoracoscopic surgery experience in such a public hospital. Methods: We have performed 10 non-intubated video-thoracoscopic surgery between March 2022 and November 2023. Seven patients were male. Single thoracic surgeon performed all the operations. Patients were analyzed in terms of characteristics, diagnosis, procedure type, operative time, analgesic methods, pain score, complications and follow-up data. Results: Mean age was 62 (29-90). Six patients underwent pleural drainage, deloculation and talk insufflation performed in two patients. Pleural biopsy was performed in one patient. Five patients were operated on due to insufficient drainage of coagulum and poor lung expansion after chest tube insertion for hemothorax. No patients required intubation. Operative mortality wasn’t seen. Eight patients received erector spinae plane block. The mean operation duration was 41 minutes. No operation related complication was observed. Average Visual Analogue Scale in 24 hours was 0-1 The mean length of hospital stay was 5 (2-10) days. Conclusion: Carefully planned thoracic surgeries for pleural pathologies can be performed with a non-intubated video-thoracoscopic approach safely. Respiratory management during surgery and perioperative management of pain is crucial to achieve best results with low operative risk. Authors suggest that the surgeon and anesthesiologist must be trained in a high volume thoracic surgery center.