Résumé
Background: in recent years, and in an attempt to reduce adverse events related to general anesthesia and mechanical ventilation, non-intubated VATS (NIVATS) has been suggested as an alternative to one lung ventilation. By relying solely on locoregional anesthesia and light sedation in spontaneously breathing patients, NIVATS can help reduce perioperative morbidity, particularly in subjects with impaired cardiorespiratory performance. The primary aim of our retrospective observational study was to evaluate feasibility, safety and short-term outcomes of NIVATS in minor and major lung procedures at our institution.Methods: all 21 patients scheduled for NIVATS at the university hospital of Montpellier between May 2021 and September 2022 were included in this study. Surgical procedures were done under locoregional anesthesia (thoracic epidural anesthesia or paravertebral nerve blockade) and light sedation in spontaneously breathing patients. Patient’s baseline characteristics and peri/postoperative outcomes were collected retrospectively from their medical charts. The primary outcome was a surgical feasibility score ranging from 4 (excellent conditions) to 1 (unsatisfactory conditions).Results: median patient age was 71 years and median ASA score was III. We included: 14 lung biopsies for suspected interstitial lung disease, 3 talc pleurodesis for recurrent pneumothorax, one wedge resection for lung abscess, 2 lobectomies and one segmentectomy for cancerous lesions. The most common neuraxial anesthesia technique used was thoracic epidural (85%) followed by paravertebral nerve blockade (15%). Feasibility score was excellent in 76% of patients. Conversion to general anesthesia and selective intubation were needed in 14% of patients because of an epidural failure. One patient required conversion to thoracotomy because of severe lung adhesions. Interventions were well tolerated by patients with the lowestperioperative oxygen saturation median ranging at 94%. Among patients receiving lung biopsy for suspected interstitial lung disease, no acute pulmonary exacerbation was recorded in the following month. Median hospital stay was 2 days. The median operative duration was 25 minutes for lung biopsies, 27 minutes for talc pleurodesis and 123 minutes for lung resections. The average postoperative chest tube duration was 29 hours with 57% of chest tubes removed in PACU. Three patients presented with a prolonged air leak and one patient required another intervention a month after his lung abscess resection surgery because he developed an empyema.Conclusion: our study suggests that minor and major lung procedures can be safely performed in spontaneously breathing patients receiving locoregional anesthesia and light sedation. Nevertheless, further randomized well powered trials are needed to establish the real impact of this technique on perioperative morbidity and mortality.