title: Nonintubated uniportal thoracoscopic surgery for resection of lung lesions.
abstract: BACKGROUND
  Sporadic case reports have shown that wedge resection and lobectomy can be performed via nonintubated video-assisted thoracoscopic surgery (VATS) with a single incision. We report the feasibility and safety of nonintubated uniportal VATS for resection of various lung lesions.
  
  
  METHODS
  From January 2014 to June 2015, we retrospectively reviewed the records of 116 consecutive patients who underwent nonintubated uniportal VATS for diagnosis or treatment of lung lesions. We used a combination of intrathoracic intercostal nerve block, vagal block, and target-controlled sedation to maintain adequate anesthesia without tracheal intubation. Computed tomography (CT)-guided dye localization and anchoring sutures were applied to facilitate single-incision VATS.
  
  
  RESULTS
  Of the 116 patients, 76 (66%) presented with ground-glass nodules on preoperative CT imaging. Overall, 125 nodules were identified on CT in the 116 patients. Most lesions were less than 10 mm in size (77/125, 62%). About two-thirds of patients underwent CT-guided dye localization of the lesions before uniportal VATS. A wedge resection with or without lymphadenectomy was performed in 107 (92%) patients, segmentectomy with lymphadenectomy, in 7 (6%), and lobectomy with lymphadenectomy, in 2 (2%) patients. Five of the 116 (4.3%) patients underwent conversion to multiport VATS, and one (0.9%) patient underwent conversion to endotracheal-intubated multiport VATS. Four (3.4%) patients had operative complications including air leakage for more than 3 days, bleeding, and pneumonia. Postoperative pain was mild. The median postoperative hospital stay was 3 days. The major pathological diagnoses of the 129 resected lesions were primary lung adenocarcinoma in 82 (64%), with predominantly stage IA disease (79/82, 96%), followed by benign tumors (18/129, 14%), metastatic tumors (17/129, 13%), pre-invasive lesions of lung (8/129, 6%), lymphoma (2/129, 1.6%), and interstitial lung disease (2/129, 1.6%).
  
  
  CONCLUSIONS
  Nonintubated uniportal VATS is technically feasible, effective, and safe for diagnosis and treatment of various lung lesions in selected patients.
authors.affiliation: 1 Division of Thoracic Surgery, Department of Surgery, 2 Department of Anesthesiology, 3 Department of Nursing, 4 Department of Traumatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Wan-Ting
authors.initials: WT
authors.lastname: Hung
authors.affiliation: 1 Division of Thoracic Surgery, Department of Surgery, 2 Department of Anesthesiology, 3 Department of Nursing, 4 Department of Traumatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Hsao-Hsun
authors.initials: HH
authors.lastname: Hsu
authors.affiliation: 1 Division of Thoracic Surgery, Department of Surgery, 2 Department of Anesthesiology, 3 Department of Nursing, 4 Department of Traumatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Hung
authors.affiliation: 1 Division of Thoracic Surgery, Department of Surgery, 2 Department of Anesthesiology, 3 Department of Nursing, 4 Department of Traumatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Pei-Yin
authors.initials: PY
authors.lastname: Hsieh
authors.affiliation: 1 Division of Thoracic Surgery, Department of Surgery, 2 Department of Anesthesiology, 3 Department of Nursing, 4 Department of Traumatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Ya-Jung
authors.initials: YJ
authors.lastname: Cheng
authors.affiliation: 1 Division of Thoracic Surgery, Department of Surgery, 2 Department of Anesthesiology, 3 Department of Nursing, 4 Department of Traumatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Jin-Shing
authors.initials: JS
authors.lastname: Chen
keywords: Video-assisted thoracoscopic surgery (VATS); endotracheal intubation; lobectomy; minimally invasive surgery; nonintubated; segmentectomy; uniportal; wedge resection