Tubeless major pulmonary resections.
Por:
Lirio F, Galvez C, Bolufer S, Corcoles JM and Gonzalez-Rivas D
Publicada:
1 ago 2018
Categoría:
Pulmonary and respiratory medicine
Resumen:
From its inception, cutting edge minimally invasive thoracic surgery has pursued to barely produce patient perturbation. Although state of the art techniques such as uniportal approach have achieved a remarkable reduction in postoperative morbidity, there is still a way to go in patient comfort. A new 'tubeless' concept has surfaced as an alternative to double-lumen intubation with general anaesthesia combining non-intubated spontaneous breathing video-assisted thoracic surgery (VATS) surgery under loco-regional blockade with the avoidance of central line, epidural or urinary catheter and chest tube in selected patients. Those procedures combine the most evolved and less invasive techniques in anaesthesia, video-assisted surgery and perioperative care to cause the least trauma and allow for faster recovery. Non-intubated thoracic surgery used to rise some concerns regarding spontaneous breathing collapse, oxygenation, cough reflex triggering and mediastinal shift. Today, experienced teams in high-volume centers have proven non-intubated major lung resections are feasible and safe once those drawbacks have been overcome with the proper techniques and extensive previous expertise in VATS. Tubeless thoracic surgery is currently evolving, challenging former exclusion criteria and expanding indications to major lung resections or even tracheal and carinal resections to provide better intraoperative status and promote minimal need for recovery.
Filiaciones:
Lirio F:
Department of Thoracic Surgery, Marina Salud Hospital, Denia, Spain
:
Department of Thoracic Surgery, University General Hospital, Alicante, Spain
:
Department of Thoracic Surgery, University General Hospital, Alicante, Spain
Corcoles JM:
Department of Thoracic Surgery, University Hospital of Vinalopo, Elche, Spain
Gonzalez-Rivas D:
Department of Thoracic Surgery, Coruña University Hospital and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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