Article Abstract

Value of nonintubated thoracoscopic biopsy for mediastinal masses

Authors: Vincenzo Ambrogi, Orazio Schillaci, Filippo Tommaso Gallina, Tommaso Claudio Mineo


Background: The development and success of the nonintubated anesthesia video-assisted thoracoscopic surgery (VATS) biopsy has progressively replaced cervical mediastinoscopy, anterior mediastinotomy, and computed tomography (CT)-guided needle biopsy in the diagnosis of mediastinal masses. In this paper we have evaluated the value of this approach comparing traditional multiportal VATS in thoracic epidural anesthesia with the more recent uniportal approach under intercostal bloc.
Methods: Since October 2001 to August 2017, 213 consecutive patients underwent nonintubated biopsies of mediastinal masses. Until July 2006, the approach was multiportal in thoracic epidural anesthesia (n=68) and afterwards uniportal under intercostals bloc (n=145). Positron emission tomography (PET) was routinely performed since 2006 and allowed targeted biopsies.
Results: We had no perioperative mortality. Complication rate was lower, yet not significantly, in uniportal group (17.6% vs. 15.3%). Uniportal VATS required significantly shorter in-operatory room stay, operative time and recovery room stay with lesser economical costs. Furthermore, the approach was significantly less painful at 7 days with a better patient acceptance score at one month. One-hundred and seven patients were managed under outpatient regimen. Seventeen patients had a redo VATS biopsy. Diagnostic accuracy was improved by the use of PET.
Conclusions: Nonintubated VATS biopsy proved safe and reliable. Uniportal approach under intercostal bloc allowed shortening the operatory room utilization, reducing chronic postoperative pain and morbidity, permitting the majority of the operation to be accomplished in outpatient regimen thus ultimately reducing the economical costs.