Video-Assisted Thoracic Surgery Utilizing Local Anesthesia and Sedation: 384 Consecutive Cases

Background. Video-assisted thoracic surgery (VATS) is usually performed with general anesthesia and endotracheal intubation. There are risks to such anesthesia and some operations may not require general anesthesia or intubation. We elected to study the safety and efficacy of VATS utilizing local anesthesia, sedation, and spontaneous ventilation. Methods. The medical records of all patients undergoing VATS utilizing local anesthesia and sedation at our system's three hospitals between June 1, 2002 and June 1, 2009 were retrospectively reviewed. The authors or residents under supervision performed all procedures. Unsuccessful attempts at this technique were eligible for inclusion but there were none. No patient was excluded based on age or comorbidity. All procedures were performed in the operating room with patients in full lateral position; no patient had endotracheal intubation or epidural or nerve block analgesia. Results. Three hundred fifty-three patients ranging in age from 21 to 100 years (mean 67 years) underwent 384 VATS operations: pleural biopsy-drainage with or without talc, 244; drainage of empyema, 74; lung biopsy, 40; evacuate hemothorax, 13; pericardial window, 7; drain lung abscess, 2; treat chylothorax, 2; treat pneumothorax, 1; and biopsy mediastinal mass, 1. No patient required intubation or conversion to thoracotomy. No patient required a subsequent biopsy for diagnosis; two patients required a subsequent procedure for empyema. There were 10 complications: cerebrovascular accident, 2; atrial fibrillation, 2; persistent air leak, 2; empyema, transient renal failure, transient respiratory failure, and urinary tract infection, 1 each. There were no deaths due to operation; within 30 days 9 patients died from underlying disease and 1 from overanticoagulation. Conclusions. Video-assisted thoracic surgery utilizing local anesthesia-sedation is well tolerated, safe, and valuable for an increasing number of indications.