Background: Patients with compromised lung function or chronic obstructive pulmonary disease are considered high-risk for intubated general anesthesia, which may preclude them from surgical treatment for lung tumors. We evaluated the feasibility and safety of nonintubated video-assisted thoracoscopic surgery (VATS) for the surgical management of lung tumors in patients with compromised lung function.

Material and Method: From August 2009 to December 2014, 28 patients with compromised lung function (preoperative forced expiratory volume in 1 second, FEV1 < 70% of predicted) underwent nonintubated VATS for managing lung tumors using a combination of thoracic epidural anesthesia or intercostal nerve block and intrathoracic vagal block with target-controlled sedation.

Results: One patient (4%) required conversion to intubated one-lung ventilation because of persistent wheezing and labored breathing. Two patients (7%) developed acute exacerbations of chronic obstructive pulmonary disease, and atrial fibrillation occurred in 1 patient (4%). Five patients (18%) developed air leakage more than 5 days postoperatively while subcutaneous emphysema in 6 patients. The median durations of postoperative chest tube drainage was 3 days while the median hospital stay was 6 days.

Conclusions: Nonintubated thoracoscopic surgery is technically feasible and clinically safe for experienced surgeon and anesthesiologist. It may be applied as an alternative to intubated general anesthesia in managing lung tumors in selected patients with compromised lung function.

Nonintubated thoracoscopic surgery for lung tumors in patients with compromised lung function