Uniportal surgical biopsy, without orotraqueal intubation, without thoracic drainage in intersticial pulmonary disease: initial results.

Juliano Mendes Souza,Ariela Victória Borgmann,Ighor Ramon Pallu Doro Pereira,Paulo Cesar Buffara Boscardim,Rafael Enrique Chiaradia

doi:10.1590/0100-6991e-20202914

Juliano Mendes Souza, Ariela Victória Borgmann + Show 3 more

Open Access

https://doi.org/10.1590/0100-6991e-20202914

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Abstract

interstitial lung disease comprises a group of lung diseases with wide pathophysiological varieties. This paper aims to report the video thoracoscopic surgical biopsy in patients with interstitial lung disease through a single minimal chest incision, without orotracheal intubation, without chest drainage, and without the use of neuromuscular blockers. this study is a series of 14 cases evaluated retrospectively, descriptively, where patients underwent a pulmonary surgical biopsy from January 2019 to January 2020. The patients included in the study had diffuse interstitial lung disease without a defined etiological diagnosis. none of the patients had transoperative complications, there was no need for chest drainage in the postoperative period, and the patients pain, assessed using the verbal scale, had a mode of 2 (minimum value of 1 and maximum of 4) in the post immediate surgery and 1 (minimum value of 1 and maximum of 3) at the time of hospital discharge. The length of hospital stay was up to 24 hours, with 12 patients being discharged on the same day of hospitalization. therefore, it is concluded in this series of cases that the performance of uniportal video-assisted thoracoscopic surgery procedures to perform lung biopsies, without orotracheal intubation, without chest drainage, and without the use of neuromuscular blockers, bring benefits to the patient without compromising his safety. Further larger studies are necessary to confirm the safety and efficiency of this method.

Highlights

Interstitial lung disease (ILD) comprises a group of lung conditions with a wide range of etiologies, pathology, treatments, and prognosis[1]
Routine placement of an intercostal chest tube has been an established part of Video-assisted thoracoscopic surgery (VATS) lung biopsy, as has intubation with doublelumen tubes[3]
This study aims to report a case series of thoracoscopic surgical biopsies in patients with interstitial lung disease through a single minimum thoracic incision without intubation or chest drainage, and without the use of neuromuscular blockers

Summary

Introduction

Interstitial lung disease (ILD) comprises a group of lung conditions with a wide range of etiologies, pathology, treatments, and prognosis[1]. With the development of minimally invasive surgical techniques and advances in anesthesia, patients at higher surgical risk, as well as those with higher risk of exacerbation of the underlying lung disease, can undergo a thoracoscopic procedure[2,3]. Video-assisted thoracoscopic surgery (VATS) is a well-established technique for lung biopsy. It is safe, allows smaller incisions, shorter hospital stay, less postoperative pain, bleeding, and damage to the pulmonary function, and causes minimal postoperative discomfort[1,2]. Routine placement of an intercostal chest tube has been an established part of VATS lung biopsy, as has intubation with doublelumen tubes[3]. Complications associated with intubation, including pulmonary infections, lung injury due to pressure from ventilation or overexpansion, arrhythmia and cardiac dysfunction, bronchospasm, postoperative sore throat, and irritative cough still pose concerns[3]

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