VATS肺叶切除术治疗肺癌

Thanks to the experience gained through video-assisted thoracoscopic techniques ,enhancement of the surgical instruments and improvement of high definition cameras, most of the pulmonary resections can be performed by minimal invasive surgery.

                               
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The future of the thoracic surgery should be associated with an evolution and improvement of combined surgical and anesthetic procedures to reduce the trauma to the patient.
Traditionally intubated general anesthesia with one-lung ventilation was considered necessary for thoracoscopic major pulmonary resections . However, thanks to the advances in minimally invasive techniques, the non-intubated thoracoscopic procedures has been adapted evn to major resections. An adequate analgesia obtained from regional anesthesia tecniques allow VATS to be performed in sedated patients and the potential general anesthesia and selective ventilation related adverse effects can be avoided. The non-intubated procedures try to minimize the adverse effects of tracheal intubation and general anesthesia like intubation-related airway trauma, ventilation-induced lung injury, residual neuromuscular blockade, and postoperative nausea and vomiting.
Anesthesiologists should be acquainted with the procedure to be performed and they may also benefit from the efficient contraction of the dependent hemidiaphragm and preserved hypoxic pulmonary vasoconstriction during surgically-induced pneumothorax in spontaneous ventilation patient. However surgical team will be aware of the potential problems, and have good judgment to convert regional anesthesia in general anesthesia in enforced circumstance.
Uniportal lobectomies represent excellent ultra-minimally invasive strategies of treatment to be reliably offered in the near future to an increasing number of patients and non-intubated anesthesia techniques are an excellent combination in a fast track VATS program thoracic surgeons and anesthesiologists providing an alternative surgical option in their caring patients but an educating and training program in VATS with non-intubated patients may be needed, on the other hand, the adoption of VATS for major procedures such as anatomic lung resections and is still very novel technique and may need additional training.
Surgical techniques and the various regional anesthesia techniques as well as indications, contraindications, criteria to conversion of sedation to general anesthesia in non-intubated patients are reviewed and discussed