Video-Assisted Thoracic Surgery Utilizing Local Anesthesia and Sedation
Pp. 191-198 (8)
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
Video-assisted thoracic surgery, local anesthesia.
Department of Surgery, Sinai Hospital, Baltimore, MD, USA.