title: Awake video-assisted thoracic surgery in acute infectious pulmonary destruction.
abstract: BACKGROUND
  Many of thoracic minimally invasive interventions have been proven to be possible without general anesthesia. This article presents results of video-assisted thoracic surgery (VATS) application under local anesthesia in patients with lung abscesses and discusses its indications in detail.
  
  
  METHODS
  The study involved prospective analysis of treatment outcomes for all acute infectious pulmonary destruction (AIPD) patients undergoing VATS under local anesthesia and sedation since January 1, 2010, till December 31, 2013. Patients with pulmonary destruction cavity at periphery of large size (>5 cm) underwent non-intubated video abscessoscopy (NIVAS). Patients with pyopneumothorax (lung abscess penetration into pleural cavity) underwent non-intubated video thoracoscopy (NIVTS). Indications for NIVAS and NIVTS were as follows: cavity debridement and washing, necrotic sequestra removal, adhesion split, biopsy. All interventions were done under local anesthesia and sedation without trachea intubation and epidural anesthesia.
  
  
  RESULTS
  Sixty-five enrolled patients had 42 NIVAS and 32 NIVTS interventions, nine patients underwent two surgeries. None of the patients required trachea intubation or epidural anesthesia. In none of our cases with conversion to thoracotomy was required. Post-surgical complications developed after 11 interventions (13%): subcutaneous emphysema (five cases), chest wall phlegmon (three cases), pulmonary bleeding (two cases), and pneumothorax (one case). One patient died due to the main disease progression. In 50 patients NIVAS and NIVTS were done within 5 to 8 days after abscess/pleural cavity draining, while in other 15 patients-immediately prior to draining; both pulmonary bleeding episodes and all cases of chest wall phlegmon took place in the latter group.
  
  
  CONCLUSIONS
  NIVAS and NIVTS under local anesthesia and sedation are well tolerated by patients, safe and should be used more often in AIPD cases. Timing of NIVAS and NIVTS procedures was found to be of paramount importance for ensuring complete therapeutic effectiveness.
authors.affiliation: 1 Department of Thoracic Surgery, First Pavlov State Medical University, Saint-Petersburg, Russia ; 2 Department of Thoracic Surgery, City Hospital Nº1, Saint-Petersburg, Russia.
authors.forename: Andrey
authors.initials: A
authors.lastname: Akopov
authors.affiliation: 1 Department of Thoracic Surgery, First Pavlov State Medical University, Saint-Petersburg, Russia ; 2 Department of Thoracic Surgery, City Hospital Nº1, Saint-Petersburg, Russia.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Egorov
authors.affiliation: 1 Department of Thoracic Surgery, First Pavlov State Medical University, Saint-Petersburg, Russia ; 2 Department of Thoracic Surgery, City Hospital Nº1, Saint-Petersburg, Russia.
authors.forename: Igor
authors.initials: I
authors.lastname: Deynega
authors.affiliation: 1 Department of Thoracic Surgery, First Pavlov State Medical University, Saint-Petersburg, Russia ; 2 Department of Thoracic Surgery, City Hospital Nº1, Saint-Petersburg, Russia.
authors.forename: Pavel
authors.initials: P
authors.lastname: Ionov
keywords: Anesthesia local; lung abscess; non-intubated; thoracic surgery; video-assisted