ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Comparison of awake and intubated video-assisted thoracoscopic surgery in the diagnosis of pleural diseases: A prospective multicenter randomized trial
Celalettin Kocatürk1, Ali Cevat Kutluk2, Ozan Usluer3, Serdar Onat4, Hüseyin Ulaş Çınar5, Fazlı Yanık6, Ezgi Cesur7, Refik Ülkü4, Altemur Karamustafaoğlu6, Burçin Çelik8, Recep Demirhan7, Cem Emrah Kalafat9, Berkant Özpolat10
1Department of Thoracic Surgery, Istinye University Medical Faculty, Liv Hospital Ulus, Istanbul, Turkey
2Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
3Department of Thoracic Surgery, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey
4Department of Thoracic Surgery, Dicle University Medical Faculty, Diyarbakır, Turkey
5Department of Thoracic Surgery, Medicana International Hospital, Samsun, Turkey
6Department of Thoracic Surgery, Trakya University Medical Faculty, Edirne, Turkey
7Department of Thoracic Surgery, Kartal Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
8Department of Thoracic Surgery, Ondokuz Mayıs University Medical Faculty, Samsun, Turkey
9Department of Thoracic Surgery, Ministry of Health State Hospital, Mardin, Turkey
10Department of Thoracic Surgery, Kırıkkale University Medical Faculty, Kırıkkale, Turkey
DOI : 10.5606/tgkdc.dergisi.2019.18214
Background: This study aims to compare the safety and diagnostic accuracy of awake and intubated video-assisted thoracoscopic surgery in the diagnosis of pleural diseases.

Methods: This prospective randomized study was conducted between October 2016 and April 2018 and included 293 patients (201 males, 92 females; mean age 53.59 years; range, 18 to 90 years) from five medical centers experienced in video-assisted thoracoscopic surgery. The patients were randomized into two groups as awake video-assisted thoracoscopic surgery with sedoanalgesia (non-intubated) and video-assisted thoracoscopic surgery with general anesthesia (intubated). Patients with undiagnosed pleural effusions and pleural pathologies such as nodules and masses were included. Conditions such as pain, agitation, and hypoxia were indications for intubation. The groups were compared in terms of demographic data, postoperative pain, operative time, complications, diagnostic accuracy of the procedures, and cost. All patients completed a follow-up period of at least 12 months for samples that were non-specific, suspicious for malignancy or inadequate.

Results: Awake video-assisted thoracoscopic surgery was performed in 145 and intubated video-assisted thoracoscopic surgery was performed in 148 patients. Pleural disease was unilateral in 83% (243/293) and bilateral in 17% (50/293) of the patients. There was no difference between the groups in terms of presence of comorbidity (p=0.149). One patient in the awake video-assisted thoracoscopic surgery group (0.6%) was converted to general anesthesia due to refractory pain and agitation. As postoperative complications, fluid drainage and pneumonia were observed in one patient in the awake video-assisted thoracoscopic surgery group (0.6%) and fluid drainage was detected in one patient in the video-assisted thoracoscopic surgery group (0.6%). There were no differences in pain intensity measured with visual analog scale at postoperative 4, 8, 12, or 24 hours (p>0.05). Distribution and rates of postoperative pathological diagnoses were also similar (p=0.171). Both operative cost and total hospital cost were lower in the awake video-assisted thoracoscopic surgery group (p<0.001, p=0.001).

Conclusion: Our study showed that awake video-assisted thoracoscopic surgery is safe, has similar reliability and diagnostic accuracy compared to video-assisted thoracoscopic surgery performed under general anesthesia, and is less costly. Awake video-assisted thoracoscopic surgery can be the first method of choice in all patients, not only in those with comorbidities.

Keywords : Awake, local anesthesia, plevral effusion, thoracoscopy, video-assisted thoracoscopic surgery
Viewed : 3555
Downloaded : 790