Spontaneous pneumothorax: intubated or non-intubated surgery?

V.V. Tkalich; Yu.V.  Nedilia; V.I.  Borysova; O.V.  Galiiev; S.I.  Savoliuk

doi:10.26641/2307-0404.2024.4.319308

Authors

V.V. Tkalich Kyiv City Hospital No. 17, Laboratornyi side str., 20, Kyiv, 01133, Ukraine https://orcid.org/0000-0001-7696-8403
Yu.V. Nedilia Kyiv City Hospital No. 17, Laboratornyi side str., 20, Kyiv, 01133, Ukraine https://orcid.org/0009-0005-5860-3204
V.I. Borysova Kyiv City Hospital No. 17, Laboratornyi side str., 20, Kyiv, 01133, Ukraine https://orcid.org/0009-0009-2999-4196
O.V. Galiiev Kyiv City Hospital No. 17, Laboratornyi side str., 20, Kyiv, 01133, Ukraine https://orcid.org/0009-0006-5634-5704
S.I. Savoliuk Shupyk National Healthcare University of Ukraine, Dorohozhytska str., 9, Kyiv, 04112, Ukraine https://orcid.org/0000-0002-8988-5866

DOI:

https://doi.org/10.26641/2307-0404.2024.4.319308

Keywords:

catamenial pneumothorax, diaphragm endometriosis, spontaneous pneumothorax, non-intubated video-assisted thoracic surgery, video-assisted thoracoscopic surgery, enhanced recovery after surgery

Abstract

The aim of our clinical study was to justify and implement non-intubated video assisted thoracic surgery as a part of enhanced recovery after surgery pathway in treatment of spontaneous pneumothorax. Data of 150 patients who underwent surgical treatment were retrospectively analyzed. Among them group 1 of 75 patients underwent video-assisted thoracoscopic surgery (VATS) and group 2 of 75 patients underwent non-intubated VATS surgical treatment. All patients underwent atypical resection of the lung and pleural abrasion, diaphragm augmentation with mesh if diaphragm endometriosis was suspected. The perioperative data, short-term outcomes and recurrence rates of these two groups were compared. The two groups had comparable demographic, perioperative investigations, fluid infusions during surgery, the volume of surgery intraoperatively, blood loss, time for chest drain removal, length of stay in the hospital and the rate of complications. There were no conversions to thoracotomy or intubated general anaesthesia, no mortality. The peak end-tidal carbon dioxide was significantly higher in the non-intubated group than in the intubated group (mean: 48±8.6 vs 34±6.2 mmHg, p<0.001). The mean follow-up was 20.2±3.9 months in the non-intubated group and 24.7±4.2 months in the intubated group (p>0.05). Chest tube duration was 4.11 days in group 1 and 3.76 days in group 2. The recurrence rate of pneumothorax after surgery was 4% in both groups. Nnon-intubated video-assisted thoracic surgery for spontaneous pneumothorax could be considered a feasible, safe and effective method of treatment, even with mesh diaphragm augmentation, in cases of catamenial pneumothorax and can be a part of Enhanced Recovery After Surgery pathway. Continious follow-up and additional clinical investigations are supposed to validate the profits of the suggested approach.

References

McCarthy C, Gupta N, Johnson SR, Yu JJ, McCormack FX. Lymphangioleiomyomatosis: pathogenesis, clinical features, diagnosis, and management. Lancet Respir Med. 2021 Nov;9(11):1313-27. doi: https://doi.org/10.1016/S2213-2600(21)00228-9

Dos Santos VM, Dos Santos LAM. Catamenial pneumothorax: a rare condition. An Sist Sanit Navar. 2024 May 27;47(2):e1076. doi: https://doi.org/10.23938/ASSN.1076

Huan NC, Sidhu C, Thomas R. Pneumothorax: Classification and Etiology. Clin Chest Med. 2021 Dec;42(4):711-27. doi: https://doi.org/10.1016/j.ccm.2021.08.007

Chen PH, Hung WT, Chen JS. Nonintubated Video – Assisted Thoracic Surgery for the Management of Primary and Secondary Spontaneous Pneumothorax. Thorac Surg Clin. 2020 Feb;30(1):15-24. doi: https://doi.org/10.1016/j.thorsurg.2019.08.001

Shigenobu T, Ohtsuka T, Yoshizu A. Risk factors for the recurrence of primary spontaneous pneumothorax after video-assisted thoracoscopic surgery in patients younger than 40 years. J Thorac Dis. 2023 Jul 31;15(7):3783-90. doi: https://doi.org/10.21037/jtd-23-257

Opanasenko MS, Tereshkovych OV, Shalahai SM, Konik BM, Shestakova D, Kalenychenko MI, et al. [Application of video-assisted lung volume reduction operations in bullous emphysema of the lungs in clinical practice]. Asthma and allergy. 2023;3:58-64. Ukrainian. doi: https://doi.org/10.31655/2307-3373-2023-3-58-64

Boiko VV, Haft KL, Nakonechnyi YeV, Shylina MV. [Videotracoscopic interference with bullous emphysema complicated by spontaneous pneumothorax]. Kharkiv Surgical School. 2019;3-4(96-97):59-63. Ukrainian. doi: https://doi.org/10.37699/2308-7005.3-4.2019.11

Kutluk AC, Kocaturk CI, Akin H, Erdogan S, Bilen S, Karapinar K, et al. Which is the best minimal invasive approach for the treatment of spontaneous pneumothorax? Uniport, two, or three ports: a prospective randomized trial. Thorac Cardiovasc Surg. 2018;66:589-94. doi: https://doi.org/10.1055/s-0038-1629909

Pathak S, Caruana E, Chowdhry F. Should surgical treatment of catamenial pneumothorax include diaphragmatic repair? Interact Cardiovasc Thorac Surg. 2019 Dec 1;29(6):906-10. doi: https://doi.org/10.1093/icvts/ivz205

Sesma J, Álvarez M, Gálvez , Bolufer S, Lirio F, Mafé JJ, et al. Non-intubated VATS for the management in primary spontaneous pneumothorax. Video-assist Thorac Surg. 2019;4:23. doi: https://doi.org/10.21037/vats.2019.09.02

Hwang J, Seung Shin JS, Son JH, Min TJ. Non-intubated thoracoscopic bullectomy under sedation is safe and comfortable in the perioperative period. J Thorac Dis. 2018;10(3):1703-10. doi: https://doi.org/10.21037/jtd.2018.02.10

Guo Z, Yin W, Zhang X, Xu X, Liu H, Shao W, et al. Primary spontaneous pneumothorax: simultaneous treatment by bilateral non-intubated videothoracoscopy. Interactive CardioVascular and Thoracic Surgery. 2016;1:6. doi: https://doi.org/10.1093/icvts/ivw123

Li X, Wang X, Zhang H, Cheng H, Cao Q. Unilateral single-port thoracoscopic surgery for bilateral pneumothorax or pulmonary bullae. Journal of Cardiothoracic Surgery. 2019;14:71.

doi: https://doi.org/10.1186/s13019-019-0894-y

Koh LY, Hwang NC. Anesthesia for Nonintubated Video-Assisted Thoracoscopic Surgery. J Cardiothorac Vasc Anesth. 2023 Jul;37(7):1275-83. doi: https://doi.org/10.1053/j.jvca.2023.02.048

Gonzalez-Rivas D, Bonome C, Fieira E, Aymerich H, Fernandez R, Delgado M, et al. Non-intubated video-assisted thoracoscopic lung resections: the future of thoracic surgery? European Journal of Cardio-Thoracic Surgery. 2016;49:721-31. doi: https://doi.org/10.1093/ejcts/ezv136

Lantos J, Németh T, Barta Z, Szabó Z, Paróczai D, Varga E, et al. Pathophysiological Advantages of Spontaneous Ventilation. Front Surg. 2022 Mar 14:9:822560. doi: https://doi.org/10.3389/fsurg.2022.822560

Chen X. Efficacy of intraoperative thoracoscopic intercostal nerve blocks in nonintubated and intubated video-assisted thoracic surgery. J Formos Med Assoc. 2024 Aug;123(8):920. doi: https://doi.org/10.1016/j.jfma.2024.01.008

Chiang X-H, Lin M-W. Converting to Intubation During Non-intubated Thoracic Surgery: Incidence, Indication, Technique, and Prevention. Front Surg. 2021 Oct 26:8:769850. doi: https://doi.org/10.3389/fsurg.2021.769850

Fabo C, Oszlanyi A, Lantos J, Rarosi F, Hor-vath T, Barta Z, et al. Non-intubated Thoracoscopic Surgery-Tips and Tricks From Anesthesiological Aspects: A Mini Review. Front Surg. 2022 Feb 11;8:818456. doi: https://doi.org/10.3389/fsurg.2021.818456

Liu J, Cui F, Li S, Chen H, Shao W, Liang L, et al. Nonintubated video-assisted thoracoscopic surgery under epidural anesthesia compared with conventional anesthetic option: a randomized control study. Surg Innov. 2015;22:123-30. doi: https://doi.org/10.1177/1553350614531662

Anile M, Vannucci J, Ferrante F, Bruno K, De Paolo D, Bassi M, et al. Non-Intubated Thoracic Surgery: Standpoints and Perspectives. Front Surg. 2022 Jul 01:9:937633. doi: https://doi.org/10.3389/fsurg.2022.937633

Yanik F. Current overview of awake, non-intubated, video-assisted thoracic surgery. Wideochir Inne Tech Maloinwazyjne. 2023 Sep;18(3):445-52. doi: https://doi.org/10.5114/wiitm.2023.128070

Elkhouly AG, Karamustafaoglu YA, Galvez C, Rao M, Lerut P, Grimonprez A, et al. Nonintubated versus intubated thoracoscopic bullectomy for primary spon-taneous pneumothorax: A multicenter propensity-matched analysis. Asian Cardiovasc Thorac Ann. 2022 Nov;30(9):1010-6. doi: https://doi.org/10.1177/02184923221129239

Kiss G. Technical Issues and Patient Safety in Nonintubated Thoracic Anesthesia. Thorac Surg Clin. 2020;30(1):1-13. doi: https://doi.org/10.1016/j.thorsurg.2019.09.001