ABSTRACT
Background: Video-assisted thoracoscopic surgery [VATS] was implemented as a minimally-invasive technique to reduce tissue trauma. Thoracic epidural anesthesia furtherly-reduces intra-operative metabolic stress, postoperative pain, in addition to supporting awake VATS, by which then completely avoiding the drawbacks of mechanical ventilation and general anesthesia in high-risk patients. In this study we report the safety and experience with using VATS in patients where general anesthesia was deemed unsafe or not suitable. The VATS procedure was done in awake patients utilizing thoracic epidural analgesia and I.V sedation
Methods: In this prospective study twenty five patients underwent VAT surgery for different thoracic pathologies at New Kasr El Aini Teaching Hospital, Cairo University between February 2005 and December 2006. There were 19 male and 6 females ranging in age from 55 to 79 years and their body mass index ranging from 25 to 31. All patients had various co-morbid conditions [hepatic, cardiac, renal and/or respiratory compromise] hence general anesthesia was deemed a hazardous option
Results: Twenty five patients underwent 28 VAT procedures which included pleural biopsy and talc poudrage in 7 patients; bullectomy in 7 patients; pleuropericardial window in 4 patients; lung biopsy in 4 patients; evacuation of clotted hemothorax in 2 patients; and wedge resection of pulmonary nodule in 1 patient. There were no morbidity or mortality related to the procedure. However there were 2 late mortalities which were attributed to the primary disease
Conclusion: Awake video-assisted thoracoscopic procedure was carried out in various thoracic pathologies with technical ease and minimal morbidity and mortality complications. In our experience this procedure is considered soundly-safe particularly in patients athigh risk for general anesthesia