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. Presently at our institution all stable patients with large unilateral pleural effusion, Stage I and II empyema, pericardial effusion with coexisting pleural effusion, diffuse lung disease, or multiple lung nodules are offered local anesthesia and sedation. No patient is excluded based on age or comorbidity.
Details of the technique are presented in this chapter. All operations are performed in the operating room with the patient in full lateral position.
Of 384 consecutive patients reported in 2010, no patient required intraoperative intubation or epidural or nerve block analgesia. No patient required conversion to thoracotomy. Diagnosis was achieved, without need for additional procedure, in all cases of biopsy; 2 patients (3% of 74) required a subsequent procedure for empyema. No patient had awareness or memory of the operation. There were 10 complications (3%) and no deaths due to operation.
VATS utilizing local anesthesia/sedation is well tolerated, safe, and valuable for an increasing number of indications.