Awake Video-Assisted Thoracic Surgery Shown As Option for Patients with Poor Pulmonary Function

Of the 246 patients who underwent lung resections, 203 patients had a FEV1 less than 0.8.

Ara Klijian, MD

Awake video-assisted thoracoscopic surgery (AVATS) is a safe and effective alternative for patients with poor lung function and lung cancer who are often precluded from surgical therapy and classified inoperable.

A new study presented at the 2018 American Thoracic Society International Conference in San Diego, demonstrated the patient safety was not comprised while undergoing AVATS and that in fact, patients had a lower length of stay (1.6 days for patients who had a lobectomy) and better patient satisfaction.

“Video-assisted thoracoscopic surgery (VATS) is a well-established procedure, but patients with poor pulmonary function often cannot have it because it is risky for them to go under general anesthesia,” study author, Ara Klijian, MD, Sharp Grossmont Hospital, Scripps Mercy Hospital, said. “I extended the VATS procedure so that it is done under local anesthesia with sedation. This enabled me to do a variety of procedures including lobectomies, esophageal surgeries, decortications and other types of thoracic surgery, with better outcomes.”

Throughout the last 5 years, more than 500 AVATS procedures have been performed without significant mortality or morbidity.

Patients often times present with multiple comorbidities including diabetes, COPD, atrial fibrillation, hypertension and hepatic and/or renal dysfunction, which typically increase risk of surgical complications.

Of the 246 patients who underwent lung resections, 203 patients had a forced expiratory volume in 1 second (FEV1) less than 0.8.

Klijian emphasizes that postoperative care needs to be streamlined to minimize use of central lines, arterial, urinal and epidural catheters to minimize nosocomial infections.

“By eliminating the need for endotracheal intubation and the comorbidity associated with general anesthesia, the AVATS procedure brings new, previously considered inoperable patients into the surgical arena,” Klijian concluded. “My long-term data have shown that this approach has been outcomes than traditional lung surgery with this select group of patients. It also reduces risks of hospital-acquired infection, as outpatient postoperative care minimizes the use of catheters.”

By eliminating use of a general anesthetic, the procedure shortened the average hospital stay was shortened, provided quicker patients recovery and improved patient and physician satisfaction and presumably obtained cost savings.

Reported mortality rates in patients with malignancy or poor cardiopulmonary status are often shown to be the highest and these patients may benefit the most from the approach.

With proper patient selection and careful preoperative planning, AVATS may be safely used to perform complex thoracic surgery with equal or improved outcome without comprise in patient safety.

The availability of the procedure is expected to increase.

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