Non-intubated Uniportal VATS Major Pulmonary Resections

  • Diego Gonzalez-RivasEmail author
  • Sonia Alvarado
  • César Bonome


Video-assisted thoracic surgery, initially developed and used only in minor procedures like biopsies or athipical resections, has been extended swiftly; and nowadays it is positioned as the first option for almost all procedures, like lobectomies or even pneumonectomies. In this field uniportal video-assisted thoracic surgery represents and excellent, minimally invasive strategy, allowing us to change our anesthesic management, evolving from the current standard management, which includes general anesthesia, intubation and one-lung ventilation, to spontaneous ventilation accompanied by different regional anesthesia techniques. We achieve with this new approach to reduce our patient’s trauma and postoperative pain caused both by more aggressive surgical techniques and more invasive anesthesia approaches; without compromising efficiency.

Supplementary material

Video 1

Non intubated uniportal anatomic apical segmentectomy (S1) (MP4 205421 kb)


  1. 1.
    Shaw JP, Dembitzer FR, Wisnivesky JP, Litle VR, Weiser TS, Yun J, et al. Video-assisted thoracoscopic lobectomy: state of the art and future directions. Ann Thorac Surg. 2008;85(2):S705–9.CrossRefGoogle Scholar
  2. 2.
    Kao MC, Lan CH, Huang CJ. Anesthesia for awake video-assisted thoracic surgery. Acta Anaesthesiol Taiwanica. 2012;50(3):126–30.CrossRefGoogle Scholar
  3. 3.
    Chen KC, Cheng YJ, Hung MH, Tseng YD, Chen JS. Nonintubated thoracoscopic lung resection: a 3-year experience with 285 cases in a single institution. J Thorac Dis. 2012;4(4):347–51.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Gónzalez-Rivas D, Aymerich H, Bonome C, Fieira E. From open operations to nonintubated video-assisted thoracoscopic lobectomy: minimizing the trauma to the patient. Ann Thorac Surg. 2015;100(6):2003–5.CrossRefGoogle Scholar
  5. 5.
    Della Rocca G, Coccia C. Acute lung injury in thoracic surgery. Curr Opin Anaesthesiol. 2013;26(1):40–6.CrossRefGoogle Scholar
  6. 6.
    Schilling T, Kozian A, Huth C, Buhling F, Kretzschmar M, Welte T, et al. The pulmonary immune effects of mechanical ventilation in patients undergoing thoracic surgery. Anesth Analg. 2005;101(4):957–65.CrossRefGoogle Scholar
  7. 7.
    Nagendran J, Stewart K, Hoskinson M, Archer SL. An anesthesiologist’s guide to hypoxic pulmonary vasoconstriction: implications for managing single-lung anesthesia and atelectasis. Curr Opin Anaesthesiol. 2006;19(1):34–43.CrossRefGoogle Scholar
  8. 8.
    Gothard J. Lung injury after thoracic surgery and one-lung ventilation. Curr Opin Anaesthesiol. 2006;19(1):5–10.CrossRefGoogle Scholar
  9. 9.
    Laffey JG, Honan D, Hopkins N, Hyvelin JM, Boylan JF, McLoughlin P. Hypercapnic acidosis attenuates endotoxin-induced acute lung injury. Am J Respir Crit Care Med. 2004;169(1):46–56.CrossRefGoogle Scholar
  10. 10.
    Feihl F, Perret C. Permissive hypercapnia. How permissive should we be? Am J Respir Crit Care Med. 1994;150(6):1722–37.CrossRefGoogle Scholar
  11. 11.
    Fitzmaurice BG, Brodsky JB. Airway rupture from double-lumen tubes. J Cardiothorac Vasc Anesth. 1999;13(3):322–9.CrossRefGoogle Scholar
  12. 12.
    Sessler DI, Sigl JC, Kelley SD, Chamoun NG, Manberg PJ, Saager L, et al. Hospital stay and mortality are increased in patients having a “triple low” of low blood pressure, low bispectral index, and low minimum alveolar concentration of volatile anesthesia. Anesthesiology. 2012;116(6):1195–203.CrossRefGoogle Scholar
  13. 13.
    Welvaart WN, Paul MA, Stienen GJ, van Hees HW, Loer SA, Bouwman R, et al. Selective diaphragm muscle weakness after contractile inactivity during thoracic surgery. Ann Surg. 2011;254(6):1044–9.CrossRefGoogle Scholar
  14. 14.
    Hausman MS Jr, Jewell ES, Engoren M. Regional versus general anesthesia in surgical patients with chronic obstructive pulmonary disease: does avoiding general anesthesia reduce the risk of postoperative complications? Anesth Analg. 2014;120(6):1405–12.CrossRefGoogle Scholar
  15. 15.
    Vanni G, Tacconi F, Sellitri F, Ambrogi V, Mineo TC, Pompeo E. Impact of awake videothoracoscopic surgery on postoperative lymphocyte responses. Ann Thorac Surg. 2010;90(3):973–8.CrossRefGoogle Scholar
  16. 16.
    Snyder GL, Greenberg S. Effect of anaesthetic technique and other perioperative factors on cancer recurrence. Br J Anaesth. 2010;105(2):106–15.CrossRefGoogle Scholar
  17. 17.
    Yan TD. Video-assisted thoracoscopic lobectomy-from an experimental therapy to the standard of care. J Thorac Dis. 2013;5(Suppl 3):S175–6.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Lin XM, Yang Y, Chi C, Liu Y, Xie DY. Video-assisted thoracoscopic lobectomy: single-direction thoracoscopic lobectomy. J Thorac Dis. 2013;5(5):716–20.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Piccioni F, Langer M, Fumagalli L, Haeusler E, Conti B, Previtali P. Thoracic paravertebral anaesthesia for awake video-assisted thoracoscopic surgery daily. Anaesthesia. 2010;65(12):1221–4.CrossRefGoogle Scholar
  20. 20.
    Rocco G, La Rocca A, Martucci N, Accardo R. Awake single-access (uniportal) video-assisted thoracoscopic surgery for spontaneous pneumothorax. J Thorac Cardiovasc Surg. 2011;142(4):944–5.CrossRefGoogle Scholar
  21. 21.
    Inoue K, Moriyama K, Takeda J. Remifentanil for awake thoracoscopic bullectomy. J Cardiothorac Vasc Anesth. 2010;24(2):386–7.CrossRefGoogle Scholar
  22. 22.
    Katlic MR, Facktor MA. Video-assisted thoracic surgery utilizing local anesthesia and sedation: 384 consecutive cases. Ann Thorac Surg. 2010;90(1):240–5.CrossRefGoogle Scholar
  23. 23.
    Hwang J, Min T, Kim D, Shin J. Non-intubated single port thoracoscopic procedure under local anesthesia with sedation for a 5-year-old girl. J Thorac Dis. 2014;6(7):148–51.Google Scholar
  24. 24.
    Macchiarini P, Rovira I, Ferrarello S. Awake upper airway surgery. Ann Thorac Surg. 2010;89(2):387–90;discussion 90–91.CrossRefGoogle Scholar
  25. 25.
    Mineo TC, Pompeo E, Mineo D, Tacconi F, Marino M, Sabato AF. Awake nonresectional lung volume reduction surgery. Ann Surg. 2006;243(1):131–6.CrossRefGoogle Scholar
  26. 26.
    Chen JS, Cheng YJ, Hung MH, Tseng YD, Chen KC, Lee YC. Nonintubated thoracoscopic lobectomy for lung cancer. Ann Surg. 2011;254(6):1038–43.CrossRefGoogle Scholar
  27. 27.
    Gonzalez-Rivas D, Bonome C, Fieira E, Aymerich H, et al. Non-intubated video-assisted thoracoscopic lung resections: the future of thoracic surgery? Eur J Cardiothorac Surg. 2016;49(3):721–31.CrossRefGoogle Scholar
  28. 28.
    Gonzalez-Rivas D, Fernandez R, de la Torre M, Rodriguez JL, Fontan L, Molina F. Single-port thoracoscopic lobectomy in a nonintubated patient: the least invasive procedure for major lung resection? Interact Cardiovasc Thorac Surg. 2014;19(4):552–5.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Diego Gonzalez-Rivas
    • 1
    • 2
    Email author
  • Sonia Alvarado
    • 3
  • César Bonome
    • 3
  1. 1.Department of Thoracic SurgeryShanghai Pulmonary Hospital, Tongji University School of MedicineShanghaiChina
  2. 2.Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI)Coruña University HospitalCoruñaSpain
  3. 3.Anesthesiology DepartmentUniversity Hospital La CoruñaLa CoruñaSpain

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