Abstract
Non-intubated, video-assisted thoracoscopic surgery (NiVATS) has been successfully developed in several centres worldwide. Local anaesthesia techniques and techniques to perform thoracoscopic surgery on a spontaneously breathing lung are the two key elements which must be adopted to establish a NiVATS programme. We established NiVATS by performing bilateral, uniportal sympathectomies, and compared it to classical video-assisted thoracoscopic surgery (VATS) under general anaesthesia with double-lumen intubation. Ten consecutive bilateral VATS sympathectomies were compared with ten consecutive NiVATS procedures. Nineteen of the procedures were for palmar hyperhidrosis and one was for facial blushing. Duration of anaesthesia, surgery and hospitalisation, perioperative complications, side effects and quality of life before and after sympathectomy were analysed. Median age was 26.5 years (range 17–55) and mean BMI in the NiVATS group was 21.8 (range 19.1–26.3). NiVATS sympathectomies were performed as outpatient procedures significantly more often (9/10 vs 3/10, p = 0.008). Quality of life was significantly increased after sympathectomy in all patients, with no significant differences between the NiVATS and the VATS groups. There were no differences between the two groups regarding compensatory sweating (40 vs 50%, p = 0.66). The duration of anaesthesia, not including the time required for the surgery, was significantly shorter in the NiVATS group (p <0.001). The duration of surgery, from the first local anaesthesia until the last skin suture, was significantly longer in the NiVATS group (p = 0.04), but showed a constant decline during the learning curve, from 95 minutes initially to 48 minutes for the last procedure. Costs were significantly lower in the NiVATS group (p = 0.04). Thoracoscopic sympathectomy is a suitable procedure with which to establish a NiVATS programme. Patients are usually young and of healthy weight, facilitating the learning curve for the local anaesthesia techniques and the surgery. Compared to VATS, sympathectomy is more likely to be performed as an outpatient procedure and has a lower cost, while safety and efficacy are maintained.
Highlights
During the past 15 years, non-intubated, video-assisted thoracoscopic surgery (NiVATS) has been successfully introduced and developed in several centres worldwide [1–3]
NiVATS sympathectomies were performed as outpatient procedures significantly more often (9/10 vs 3/ 10, p = 0.008)
Quality of life was significantly increased after sympathectomy in all patients, with no significant differences between the NiVATS and the VATS groups
Summary
During the past 15 years, non-intubated, video-assisted thoracoscopic surgery (NiVATS) has been successfully introduced and developed in several centres worldwide [1–3]. The use of a simple, intravenous drug regime for analogue sedation, rigorous local infiltration anaesthesia and intercostal nerve blocks prevents postoperative discomforts such as pain, sore throat and coughing, and shortens the recovery time [4–6]. A recent randomised study compared NiVATS procedures under epidural anaesthesia with thoracic surgery operations under general anaesthesia [7]. Only Elia and colleagues have compared NiVATS sympathectomy with sympathectomy under general anaesthesia [9]. They found no difference in postoperative quality of life, but better patient satisfaction and reduced costs af-
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
