title: Non-intubated video-assisted thoracic surgery management of secondary spontaneous pneumothorax.
abstract: Secondary spontaneous pneumothorax (SSP) is serious entity, usually due to underlying disease, mainly chronic obstructive pulmonary disease (COPD). Its morbidity and mortality is high due to the pulmonary compromised status of these patients, and the recurrence rate is almost 50%, increasing mortality with each episode. For persistent or recurrent SSP, surgery under general anesthesia (GA) and mechanical ventilation (MV) with lung isolation is the gold standard, but ventilator-induced damages and dependency, and postoperative pulmonary complications are frequent. In the last two decades, several groups have reported successful results with non-intubated video-assisted thoracic surgery (NI-VATS) with thoracic epidural anesthesia (TEA) and/or local anesthesia under spontaneous breathing. Main benefits reported are operative time, operation room time and hospital stay reduction, and postoperative respiratory complications decrease when comparing to GA, thus encouraging for further research in these moderate to high risk patients many times rejected for the standard regimen. There are also reports of special situations with satisfactory results, as in contralateral pneumonectomy and lung transplantation. The aim of this review is to collect, analyze and discuss all the available evidence, and seek for future lines of investigation.
authors.affiliation: 1 Thoracic Surgery Service, 2 Anethesiologist and Surgical Critical Care Service, University General Hospital of Alicante, C/Pintor Baeza 12, 03010, Alicante, Spain ; 3 Thoracic Surgery Service, Vinalopo Hospital, C/Tonico Sansano Mora 14, 03293 Elche, Alicante, Spain ; 4 Thoracic Surgery, Alicante, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Galvez
authors.affiliation: 1 Thoracic Surgery Service, 2 Anethesiologist and Surgical Critical Care Service, University General Hospital of Alicante, C/Pintor Baeza 12, 03010, Alicante, Spain ; 3 Thoracic Surgery Service, Vinalopo Hospital, C/Tonico Sansano Mora 14, 03293 Elche, Alicante, Spain ; 4 Thoracic Surgery, Alicante, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Bolufer
authors.affiliation: 1 Thoracic Surgery Service, 2 Anethesiologist and Surgical Critical Care Service, University General Hospital of Alicante, C/Pintor Baeza 12, 03010, Alicante, Spain ; 3 Thoracic Surgery Service, Vinalopo Hospital, C/Tonico Sansano Mora 14, 03293 Elche, Alicante, Spain ; 4 Thoracic Surgery, Alicante, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Navarro-Martinez
authors.affiliation: 1 Thoracic Surgery Service, 2 Anethesiologist and Surgical Critical Care Service, University General Hospital of Alicante, C/Pintor Baeza 12, 03010, Alicante, Spain ; 3 Thoracic Surgery Service, Vinalopo Hospital, C/Tonico Sansano Mora 14, 03293 Elche, Alicante, Spain ; 4 Thoracic Surgery, Alicante, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Lirio
authors.affiliation: 1 Thoracic Surgery Service, 2 Anethesiologist and Surgical Critical Care Service, University General Hospital of Alicante, C/Pintor Baeza 12, 03010, Alicante, Spain ; 3 Thoracic Surgery Service, Vinalopo Hospital, C/Tonico Sansano Mora 14, 03293 Elche, Alicante, Spain ; 4 Thoracic Surgery, Alicante, Spain.
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Corcoles
authors.affiliation: 1 Thoracic Surgery Service, 2 Anethesiologist and Surgical Critical Care Service, University General Hospital of Alicante, C/Pintor Baeza 12, 03010, Alicante, Spain ; 3 Thoracic Surgery Service, Vinalopo Hospital, C/Tonico Sansano Mora 14, 03293 Elche, Alicante, Spain ; 4 Thoracic Surgery, Alicante, Spain.
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Rodriguez-Paniagua
keywords: Thoracic surgery; anesthesia; epidural; mechanical; pneumothorax; ventilation; video-assisted