title: Nonintubated thoracoscopic lobectomy for lung cancer.
abstract: OBJECTIVE
  To evaluate the feasibility and safety of thoracoscopic lobectomy without endotracheal intubation.
  
  
  BACKGROUND
  General anesthesia with single-lung ventilation is considered mandatory for thoracoscopic lobectomy for non-small cell lung cancer (NSCLC). Nonintubated thoracoscopic lobectomy has not been reported previously.
  
  
  METHODS
  From August 2009 through June 2010, some 30 consecutive patients with clinical stage I or II NSCLC were treated by nonintubated thoracoscopic lobectomy using epidural anesthesia, intrathoracic vagal blockade, and sedation. To evaluate the feasibility and safety of this novel technique, they were compared with a control group consisting of 30 consecutive patients with clinical stage I or II NSCLC who underwent thoracoscopic lobectomy using intubated general anesthesia from August 2008 through July 2009.
  
  
  RESULTS
  Collapse of the operative lung and inhibition of coughing were satisfactory in the nonintubated patients, induced by spontaneous breathing, and vagal blockade. Three patients in the nonintubated group required conversion to intubated-single lung ventilation because of persistent hypoxemia, poor epidural anesthesia pain control, and bleeding. One patient in each group was converted to thoracotomy because of bleeding. The 2 groups had comparable anesthesia durations, surgical durations, blood loss, and numbers of dissected lymph nodes. Patients who underwent nonintubated surgery had lower rates of sore throat (6.7% vs 40.0%, P = 0.002) and earlier resumption of oral intake (mean, 4.7 hours vs 18.8 hours, P < 0.001). Patients undergoing nonintubated surgery also had a trend toward better noncomplication rates (90% vs 66.7%, P = 0.057) and shorter postoperative hospital stays (mean, 5.9 days vs 7.1 days, P = 0.078).
  
  
  CONCLUSIONS
  Nonintubated thoracoscopic lobectomy is technically feasible and is as safe as lobectomy performed with intubation in highly selected patients. It can be a valid alternative of single-lung-ventilated thoracoscopic surgery in managing early-stage NSCLC.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Jin-Shing
authors.initials: JS
authors.lastname: Chen
authors.forename: Ya-Jung
authors.initials: YJ
authors.lastname: Cheng
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Hung
authors.forename: Yu-Ding
authors.initials: YD
authors.lastname: Tseng
authors.forename: Ke-Cheng
authors.initials: KC
authors.lastname: Chen
authors.forename: Yung-Chie
authors.initials: YC
authors.lastname: Lee
mesh_terms: D000328:Adult; D000770:Anesthesia, Endotracheal; D000767:Anesthesia, Epidural; D001340:Autonomic Nerve Block; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D016292:Procedural Sedation; D005240:Feasibility Studies; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D013624:Taiwan; D013906:Thoracoscopy / Q000379:methods*; D014630:Vagus Nerve