Awake Thoracic Surgery


by

Eugenio Pompeo

DOI: 10.2174/97816080528821120101
eISBN: 978-1-60805-288-2, 2012
ISBN: 978-1-60805-651-4



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Indexed in: Book Citation Index, Science (BKCI-S), Web of Science, Scopus

Awake thoracic surgery is a new surgical field that is set to expand in the near future. Employing sole epidural or local anaesthesia ...[view complete introduction]

Table of Contents

Foreword

- Pp. i

Thomas A. D’Amico

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Preface

- Pp. ii

Eugenio Pompeo

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List of Contributors

- Pp. iii-iv (2)

Eugenio Pompeo

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Acknowledgement

- Pp. v

Eugenio Pompeo

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Awake Thoracic Surgery: A Historical Perspective

- Pp. 3-8 (6)

Eugenio Pompeo and Tommaso Claudio Mineo

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Pathophysiology of Surgical Pneumothorax in the Awake Patient

- Pp. 9-18 (10)

Eugenio Pompeo

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Systemic Host Response in Awake Thoracic Surgery

- Pp. 19-33 (15)

Federico Tacconi, Gianluca Vanni and Eugenio Pompeo

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Adverse Effects of General Anesthesia in Thoracic Surgery

- Pp. 34-42 (9)

Mario Dauri, Ludovica Celidonio, Sarit Nahmias, Florencia Della Badia, Filadelfo Coniglione and Eleonora Fabbi

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Anesthesia Techniques in Awake Thoracic Surgery

- Pp. 44-73 (30)

Mario Dauri, Sarit Nahmias, Ludovica Celidonio, Elisabetta Sabato, Maria Beatrice Silvi and Eleonora Fabbi

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Awake Resection of Solitary Pulmonary Nodules

- Pp. 74-87 (14)

Eugenio Pompeo, Francesco Sellitri, Benedetto Cristino and Tommaso Claudio Mineo

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Awake Non-Resectional Lung Volume Reduction Surgery

- Pp. 88-104 (17)

Eugenio Pompeo, Ilaria Onorati and Tommaso Claudio Mineo

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Awake Lung Biopsy for Interstitial Lung Disease

- Pp. 105-118 (14)

Luca Frasca, Vincenzo Ambrogi, Paola Rogliani, Cesare Saltini and Eugenio Pompeo

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Awake Videothoracoscopic Treatment of Pleural Effusion

- Pp. 119-129 (11)

Francesco Sellitri, Federico Tacconi, Benedetto Cristino and Eugenio Pompeo

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Awake Thoracoscopic Treatment of Spontaneous Pneumothorax

- Pp. 130-140 (11)

Gianluca Vanni, Federico Tacconi, Tommaso Claudio Mineo and Eugenio Pompeo

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Awake Pleural Decortication for Empyema Thoracis

- Pp. 141-154 (14)

Federico Tacconi and Eugenio Pompeo

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Awake Thymectomy

- Pp. 155-164 (10)

Isao Matsumoto and Makoto Oda and Go Watanabe

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Awake Thoracoscopic Biopsy of Anterior Mediastinal Masses

- Pp. 165-176 (12)

Eugenio Pompeo, Alessandra Picardi, Maria Cantonetti and Tommaso Claudio Mineo

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Awake Thoracoscopic Sympathectomy

- Pp. 177-190 (14)

Maria Elena Cufari, Eugenio Pompeo, Tommaso Claudio Mineo and Vincenzo Ambrogi

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Video-Assisted Thoracic Surgery Utilizing Local Anesthesia and Sedation

- Pp. 191-198 (8)

Mark Katlic

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Awake Thoracic Surgery: Future Perspectives

- Pp. 199-201 (3)

Eugenio Pompeo

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Subject Index

- Pp. 202-203 (2)

Eugenio Pompeo

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Foreword

Minimally invasive thoracic surgery has been demonstrated to achieve superior outcomes for patients with basic and complex thoracic conditions. Advantages of thoracoscopic surgery include less postoperative pain, faster return to full activity, preserved pulmonary function, shorter length of hospitalization, reduced inflammatory response, and a lower rate of postoperative complications. With increasing experience, the boundaries of thoracoscopy have dissolved and the strategies of minimally invasive surgery have expanded. In particular, the concept of awake thoracic surgery has emerged as an important novel strategy to optimize the advantages of minimally invasive surgery.

Awake thoracoscopic surgery encompasses the advantages of limiting the invasiveness of both anesthesia and surgery, which may magnify the known benefits of minimally invasive thoracic surgery. Although initially applicable to only the most basic procedures, awake thoracoscopic strategies are currently used to successfully complete advanced procedures as well, including lung volume reduction, decortication, and thymectomy. Whereas the recognition of the advantages of thoracoscopic surgery has been slow in evolution, it is hoped that the strategy of awake thoracoscopic surgery is more promptly understood and embraced. This monograph by Dr. Eugenio Pompeo outlines both the theoretical and proved advantages of the anesthetic and surgical techniques that are employed in awake surgery. In addition, the results of a spectrum of awake thoracoscopic surgery, including both basic and complex procedures, are described in detail by the recognized experts in the field. Awake thoracic surgery will eventually be included in thoracic surgery training programs, but until then the practicing thoracic surgeon should learn this important strategy, and this monograph represents a comprehensive and valuable summary.

Thomas A. D’Amico
Professor of Surgery
Duke University Medical Center
Durham, North Carolina


Preface

Health care in our era is dominated by an increasing attention to patients’ quality of life and cost to benefit ratio of therapies. For these reasons, interest towards minimally invasive surgery procedures that are typically associated with minor postoperative pain and morbidity, short hospitalization and optimal cosmesis, continues to grow. Awake thoracic surgery is being developed according to the idea that making thoracic surgery procedures less and less aggressive can be a feasible task. Theoretically, the avoidance of well known adverse effects of general anesthesia and one-lung ventilation could translate into some advantages including a smoother postoperative course, a more rapid resumption of daily-life activities, and even an opportunity to offer surgical treatment to patients in whom this would be denied because of a high-risk for standard surgery.

The reader will have the opportunity to acknowledge that, though awake thoracic surgery is a totally explorable novel surgical field, many of the concepts we advocate today had already been hypothesized in the past by pioneer surgeons, whereas some of the fears of yesterday now prove either groundless, thanks to a better knowledge in cardiopulmonary physiology, or easily surmountable by our current technology. However, despite the enthusiasm and encouraging initial results, there is still a long way to go. Many pathophysiologic aspects as well as real advantages and cost-effectiveness of these novel options need to be better elucidated. Alternative non-surgical treatment procedures are being developed to cure a number of thoracic conditions and it is likely that many valid surgical procedures of today will become obsolete within a few years.

Awake thoracic surgery might represent one strong answer to this challenge and the aim of this e-Book is to provide a first overview on current advances matured in this exciting surgical field. Following some historical notes, the main pathophysiologic aspects of epidural anesthesia and the surgical pneumothorax in the awake patient, are focused to provide insights on intraoperative changes in oxygenation, ventilation and the main cardiopulmonary variables. In addition, the low impact of awake thoracic surgery on postoperative immunologic and stress hormone responses is also analyzed in detail. Chapters on surgical techniques include a description of the advantages, indications, technical details and results of several surgical procedures including the promising non-resectional awake lung volume reduction surgery technique for the treatment of end-stage emphysema, pulmonary resections and thymectomy.

This monograph is the result of a multi-mind effort and I want to thank all the authors for their excellent contributions. Some of them are talented young researchers from our own University, whereas others are well-known thoracic surgeons from other countries who are actively involved in awake thoracic surgery programs. I greatly thank my mentor, Prof. Mineo, who has given me the opportunity to be fully involved in advanced videothoracoscopic surgery, to apply my ideas and to develop our awake thoracic surgery clinical program. He constantly guided me in the art of surgery with his advice and constructive comments arising from an unexceptionable 40-year based full-time academic practice in thoracic surgery.

I am particularly grateful to Bentham Science Publishers that believed in this project and allowed its realization. The modern formula of an e-monograph has made it possible to include rich iconographic and multimedia material that will facilitate diffusion and understanding of the various topics.

Enjoy your reading.

Eugenio Pompeo
Associate Professor
Department of Thoracic Surgery
Policlinico Tor Vergata University
Rome, Italy

List of Contributors

Editor(s):
Eugenio Pompeo
Tor Vergata University
Rome
Italy




Contributor(s):
Vincenzo Ambrogi
Associate Professor, Department of Thoracic Surgery
Tor Vergata University
Rome
Italy


Maria Cantonetti
Associate Professor, Department of Onco-Hematology
Tor Vergata University
Rome
Italy


Ludovica Celidonio
Resident, Department of Anesthesiology and Intensive Care
Tor Vergata University
Rome
Italy


Filadelfo Coniglione
Assistant Professor, Department of Anesthesiology and Intensive Care
Tor Vergata University
Rome
Italy


Benedetto Cristino
Assistant Professor, Department of Thoracic Surgery
Tor Vergata University
Rome
Italy


Maria Elena Cufari
Resident, Department of Thoracic Surgery
Tor Vergata University
Rome
Italy


Thomas A. D’Amico
Professor, Section of Thoracic Surgery
Duke University Medical Center
Durham
North Carolina
USA


Mario Dauri
Associate Professor, Department of Anesthesiology and Intensive Care
Tor Vergata University
Rome
Italy


Florencia Della Badia
Resident, Department of Anesthesiology and Intensive Care
Tor Vergata University
Rome
Italy


Eleonora Fabbi
Department of Anesthesiology and Intensive Care
Tor Vergata University
Rome
Italy


Luca Frasca
Resident, Department of Thoracic Surgery
Tor Vergata University
Rome
Italy


Marc Katlic
Chairman, Department of Surgery and Surgeon-in-Chief
Sinai Hospital
MD
USA


Isao Matsumoto
Associate Professor, Department of General and Cardiothoracic Surgery
Kanazawa University
Kanazawa
Japan


Tommaso C Mineo
Professor and Head, Department of Thoracic Surgery
Tor Vergata University
Rome
Italy


Sarit Nahmias
Resident, Department of Anesthesiology and Intensive Care
Tor Vergata University
Rome
Italy


Ilaria Onorati
Department of Thoracic Surgery
Tor Vergata University
Rome
Italy


Makoto Oda
Professor, Department of General and Cardiothoracic Surgery
Kanazawa University
Kanazawa
Japan


Alessandra Picardi
Assistant Professor, Department of Onco-Hematology
Tor Vergata University
Rome
Italy


Eugenio Pompeo
Associate Professor, Department of Thoracic Surgery
Tor Vergata University
Rome
Italy


Paola Rogliani
Associate Professor, Department of Pneumology
Tor Vergata University
Rome
Italy


Elisabetta Sabato
Resident, Department of Anesthesiology, and Intensive Care
Tor Vergata University
Rome
Italy


Cesare Saltini
Professor and Head, Department of Pneumology
Tor Vergata University
Rome
Italy


Francesco Sellitri
Assistant Professor, Department of Thoracic Surgery
Tor Vergata University
Rome
Italy


Maria Beatrice Silvi
Assistant Professor, Department of Anesthesiology and Intensive Care
Tor Vergata University
Rome
Italy


Federico Tacconi
Assistant Professor, Department of Thoracic Surgery
Tor Vergata University
Rome
Italy


Gianluca Vanni
Department of Thoracic Surgery
Tor Vergata University
Rome
Italy


Go Watanabe
Professor and Chairman, Department of General and Cardiothoracic Surgery
Kanazawa University
Kanazawa
Japan




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