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Objectives To describe and assess the techniques of spontaneous-ventilation video-assisted thoracoscopic surgery (SV-VATS) for tracheal/carinal resections and compare the outcomes with the conventional thoracoscopic intubated method. Methods From May 2015 to November 2016, some 18 consecutive patients with malignant or benign diseases invading distal trachea and carina who met the criteria for SV were treated by SV-VATS resection. To evaluate the feasibility of this novel technique, they were compared with a control group consisting of 14 consecutive patients with the same diseases who underwent VATS resection using intubated general anesthesia from October 2014 to April 2015. Data were collected with a median follow-up of 10.2 months 75 (range: 1-27). Results The SV-VATS group consisted of 4 carinal resections and 14 tracheal resections. In the control group, 2 patients underwent carinal resection and 12 underwent tracheal resection. Median operative time was shorter in the SV-VATS group compared with the intubated group (162.5 minutes vs 260 minutes), as was the median time for tracheal end-to-end anastomosis (22.5 minutes vs 45 minutes) and carinal reconstruction (40 minutes vs 86 minutes). The lowest oxygen saturation during the procedure was 94.2% ± 4.9% in SV-VATS group and 93.9% ± 4.5% in the control group. The peak carbon dioxide level at the end of expiration was greater in the SV-VATS group (47.7 ± 4.2 mm Hg vs 39.1 ± 5.7 mm Hg). No conversion to tracheal intubation was needed in the SV-VATS group. Postoperative complications occurred in 6 patients in the SV-VATS group and 9 in the control group. Patients who underwent SV-VATS had a trend toward shorter postoperative hospital stays (11.5 ± 4.3 days vs 13.2 ± 6.3 days). One recurrence (SV-VATS group) and 2 deaths (one in each group) were observed during follow-up. Conclusions SV-VATS is a feasible procedure in tracheal and carinal resection and reconstruction in highly selected patients. It can be a valid alternative to conventional intubated VATS for airway surgery.

Previous tracheal surgeries were performed under tracheal and cross-field intubation. However, the intubation would lead to bleeding if the tumors were large or hemorrhagic. Moreover, the tracheal intubation might interfere the surgical vision and anastomosis during the reconstruction process. Therefore, we performed a tracheal tumor resection and reconstruction via nonintubated spontaneous anesthesia. We describe the feasibility and safety of tracheal surgeries via such anesthesia.

Background: Spontaneous ventilation VATS (SV-VATS) is reported to be associated with faster recovery and fewer complications than mechanical ventilation video-assisted thoracic surgery (MV-VATS). This study aimed to evaluate the effect of SV-VATS for patients with spontaneous pneumothorax. Methods: We performed a randomized controlled trial at 10 medical centers by recruiting primary pneumothorax patients undergoing SV-VATS and MV-VATS. Participants were randomly assigned (1:1), to receive non-intubated spontaneous ventilation (SV-VATS) or intubated mechanical one lung ventilation (MV-VATS). The primary outcome was the intraoperative surgery/anesthesia related accident rate, which was assessed according to incedences of intraoperative hypoxia, conversion to open surgery, conversion to intubation and other intraoperative adverse events that could happen in both groups. Other study outcomes included changes of vital signs, total analgesic dose, recovery time, post-operative complication rates, cost-effectiveness evaluation, etc. Findings: The trial began on Apr 10, 2017, and ended on Jan 03, 2019. During this time, 355 patients were assessed. After evaluation and randomization, 325 eligible patients were assigned to receive an SV-VATS (n=162) or MV-VATS (n=163) procedure. In the intention-to-treat analysis, there was no difference between the intraoperative accident rate of the SV-VATS (1.23%) and MV-VATS (1.23%) group (P=0.995). The SV-VATS group was associated with significantly decreased total dosage of both sufentanil (11.37 μg vs 20.92 μg; p