Video-assisted thoracoscopic surgery in local anaesthesia and analgosedation – a survey among the members of the German Society of Thoracic Surgeons

Introduction:

Video-assisted thoracoscopic procedures (VATS) with spontaneous breathing are internationally of increasing importance in the treatment of elderly and multimorbid patients. Data on application and acceptance in Germany are not yet available.

Method:

German-wide, online-based survey among the thoracic surgical departments registered at the German Society of Thoracic Surgeons (DGT) on the application of VATS in local anaesthesia (LA).

Results:

101 out of 157 hospitals responded (64%). 42% of the respondents performed non-intubated VATS (NIVATS), 31% VATS in LA. Reasons not to perform VATS in LA are lack of experience (50%), doubts about feasibility (29%) and missing indications (24%). Among the performing clinics, the most frequent procedures are pleural catheterization (94%), pleural biopsy (87%) and pleurodesis (87%). 40% of the clinics perform wedge resections and 10% also anatomical resections in LA. Main target groups are multimorbid patients (77%), elderly patients (65%), patients with anxiety about general anesthesia (55%) and with pre-existing lung diseases (52%). In 97% of the departments sedation is performed by anaesthesiologists. The main technical difficulties mentioned are impaired view of the surgical field (39%), hypercapnia (29%) and panic attacks (23%). Pain is of minor importance (3%).

Discussion:

About one third of the clinics surveyed already carry out VATS in LA, others have plans to introduce the method. The majority of respondents regard multimorbid, elderly and lung patients as the main target groups because fewer inflammatory, respiratory and neurological complications are expected. To realize the potential of VATS in LA, good patient selection and cooperation between surgery and anesthesia are required.