Abstract

OBJECTIVE: Video-assisted thoracic surgery (VATS) is usually performed under general anaesthesia. However, some pleural and pulmonary interventions may be performed under local anaesthesia with sedation. In this study, patients who underwent VATS without general anaesthesia were evaluated to determine the benefits and safety of the procedure.

MATERIAL AND METHODS: The medical records of all patients who underwent VATS with local anaesthesia and sedation between January 2007 and December 2011 were reviewed. All procedures were performed with the patient in a semi-recumbent position in an operating room. Prilocaine-HCl (20 mg/mL; 10 cc) was used for local anaesthesia. Sedation was obtained with intravenous administration of propofol (0.5 mg/kg), fentanyl (0.5-1 μg/kg) and midazolam (1-2 mg).

RESULTS: There were 67 male and 34 female patients, ranging from 17-88 years of age. Most of the awake VATS procedures were performed to evaluate pleural disease (93 patients; 92%). Pleural biopsy and/or drainage was performed in 84 patients (83.2%), pleural biopsy/ drainage with talc pleurodesis in 10 patients (9.9%), treatment of empyema in 4 patients (4%), evacuation of haemothorax in 2 patients (1.9%) and diaphragmatic pore closure in 1 patient (1%). Of the 101 patients, 90 (89.1%) had uniport VATS and 11 (10.9%) had two-port VATS. Conversion to general anaesthesia was necessary in 4% of cases due to severe coughing in 3 patients and pleural adhesions in 1 patient.

CONCLUSION: VATS utilising local anaesthesia and sedation is well tolerated and safe for diagnosis and treatment for pleural pathologies.