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RESEARCH PRODUCT

SINGLE ACCESS THORACOSCOPY IN BENIGN AND MALIGN PLEURIC PATHOLOGY

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(OBJECTIVE) Jacobeus and Bethune performed thoracoscopy under local anaesthesia, already on early 1900. A single access associated with local anaesthesia aims to improve procedure tolerance, shorten recovery and reduce costs. (METHODS) Premedication consists of atropine 0.01 mg/kg and midazolam (0,02-0.04 mg/kg). Pain control and sedation was obtained by remifentanile (0.05-0.1 mcg/kg/min). Local anaesthesia was made with lidocaine and ropivacaine. An incision of 20 mm is realised at 6° intercostal space for the “single-access-technique”, and two incisions for the “2-trocars-technique” (15 mm at 5°space - 10 mm at 6°/7°space). The 5 mm 0° camera is preferred for single-access technique. The effusion is not totally drained in order to maintain the lung collapsed, getting a better view of pleural cavity. Otherwise, it could be useful insufflating CO2. Liquid samples, multiple biopsies and eventual pleurodesis are performed. (RESULTS) Two groups of patients with pleural effusion : 95pts treated with awake technique and 79pts under general anaesthesia (Mean age 69,7 vs 63,4 statistically different p<0,05). There was no difference between the two groups for kind of operation or surgical equipe. Mortality rate was 0% in both group. Post-operative stay: 3dd ± 4 vs 4dd ± 5 Mean operative time: 39 mins vs 37 mins (p<0,05) Chest tube duration: 2dd±5 vs 3dd±6 Complications: 2/95 vs 1/79 bleeding, 2/95 vs 1/79 atrial fibrillation, 2/95 vs 3/79 subcutaneous emphysema, 0/95 vs 1/79 chylothorax, 5/95 vs 4/79 recurrence. All differences were not statistically significant. (CONCLUSIONS) Awake technique allows a reduction, although slightly, of postoperative hospital stay and duration of chest drainage, while we registered similar complications and recurrence rate. We can say that “Awake Single-Access VATS” is an optimal diagnostic and therapeutic tool for the management of benign and malignant pleural effusions, but above extends surgical indication to high-risk patients, who might not be qualified for general anaesthesia procedure.