Awake surgery for lung metastasectomy

Abstract

: Twenty years ago, we started a program of pulmonary metastasectomy by using a videothoracoscopic approach in awake non-intubated patients under local anesthesia. Since 2000 we created the project denominated “Awake Thoracic Surgery Research”. Until 2005 video assisted thoracoscopic surgery metastasectomy was performed under awake epidural anesthesia and triportal approach. From 2005 the same type of surgery has been conducted with intercostal blockade and sedation through an uniportal approach. In this article we illustrated the techniques of lung metastasectomy and in particular the combination of video-assisted thoracoscopic surgery with non-intubated anesthesia. This technique may achieve significant advantages in less overall operative time, lower post-operative morbidity rate and milder impact on inflammatory system. All this leads to a better patient satisfaction, shorter hospital-stay then lesser economical costs. Moreover, based on our experience, the non-intubated technique entails an inferior lymphocytes and natural-killer cells reduction, thus a lower immunosuppressive effect in the post-operative period. This can decrease the risk of tumor growth. Nevertheless, the awake video assisted thoracoscopic surgery metastasectomy is not suitable in every patient but it requires specific oncologic, surgical, functional, anesthesiological and psychological requirements. Then the correct selection of the patient is the key for the success of the procedure.