Nonintubated uniportal nonresectional videothoracoscopic lung volume reduction surgery

Abstract

In 2000, we developed a nonintubated lung volume reduction surgery (LVRS) technique accomplished through a multiport videothoracoscopy. More recently, we performed the same operation through a single-port approach. Hereby, we analyzed comparative merits in short and long-term periods of these two techniques. Between January 2001 and October 2015, 108 patients with severe emphysema underwent multi-portal (n=77) and uniportal (n=31) video-thoracoscopic nonresectional LVRS under nonintubated anesthesia. Respiratory and functional parameters were timely evaluated. Time to residual volume recurrence and overall survival were analyzed with the Kaplan-Meier method. Conversion rate to general anesthesia (multi vs. uniportal) was similar between groups (14.5% vs . 12.1%), whereas postoperative pain (1.8 vs . 1.3; P=0.04) and quality of life changes (+9.2% vs . +16.7%; P=0.03) after 7 days from the operation were significantly lower in uniportal group. Hospital stay (6.8 vs . 5.2 days), 90-days postoperative mortality rate (1.5% vs . 0%) and non-fatal complications rate (15.6% vs . 11.1%) were lower in uniportal group but not significant. All respiratory and symptomatic parameters significantly improved in both groups with no intergroup significant difference. Analysis of time to residual volume recurrence and overall survival showed no statistical significant difference between groups. Nonintubated, uniportal, nonresectional videothoracoscopic LVRS achieves excellent short results with less postoperative pain and better early quality of life than multi-portal operations. Uniportal group exhibited lower 90-day postoperative mortality and non-fatal complication rates even though not significantly different. Long-term outcomes were similar between groups. However, the lesser pain and discomfort of nonintubated uniportal LVRS allows easier recruitment of elderly and high-risk patients as well.