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中华胸部外科电子杂志

中华胸部外科电子杂志 ›› 2021, Vol. 08 ›› Issue (04) : 205 -208. doi: 10.3877/cma.j.issn.2095-8773.2021.04.01

国际胸外科专栏

Non-intubated minimally-invasive lung surgery in Germany-current status and outlook
Patrick Zardo1,†(), Norman Zinne1, Alaa Selman1, Hayan Merhej1, Tobias Goecke1, Henning Starke2, Daniel Jaeger2, Jan Karsten2, Axel Haverich1   
  1. 1. Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
    2. Department of Anaesthesiology, Hannover Medical School, Hannover, Germany
  • 收稿日期:2021-07-29 接受日期:2021-08-26 出版日期:2021-11-28
  • 通信作者: Patrick Zardo

Non-intubated minimally-invasive lung surgery in Germany-current status and outlook

Patrick Zardo1(), Norman Zinne1, Alaa Selman1, Hayan Merhej1, Tobias Goecke1, Henning Starke2, Daniel Jaeger2, Jan Karsten2, Axel Haverich1   

  1. 1. Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
    2. Department of Anaesthesiology, Hannover Medical School, Hannover, Germany
  • Received:2021-07-29 Accepted:2021-08-26 Published:2021-11-28
  • Corresponding author: Patrick Zardo
  • About author:
    Contributions: (I) Conception and design: P Zardo, A Haverich; (II) Administrative support: H Starke, D Jaeger, J Karsten; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: None; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.
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Patrick Zardo, Norman Zinne, Alaa Selman, Hayan Merhej, Tobias Goecke, Henning Starke, Daniel Jaeger, Jan Karsten, Axel Haverich. Non-intubated minimally-invasive lung surgery in Germany-current status and outlook[J]. 中华胸部外科电子杂志, 2021, 08(04): 205-208.

Patrick Zardo, Norman Zinne, Alaa Selman, Hayan Merhej, Tobias Goecke, Henning Starke, Daniel Jaeger, Jan Karsten, Axel Haverich. Non-intubated minimally-invasive lung surgery in Germany-current status and outlook[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2021, 08(04): 205-208.

Lung surgery under spontaneous ventilation (non-intubated video-assisted thoracoscopic surgery, niVATS) picked up a lot of momentum during the past few years. Surgeons and anesthetists alike want to forgo known risks of orotracheal intubation and mechanical ventilation, ranging from local complications, like mucosal injury or even deleterious tracheal laceration and rupture, to increased release of pro-inflammatory cytokines and diaphragmatic dysfunction secondary to muscle relaxation. Despite initial adoption of VATS in Germany having been slow due to a general reticence towards it in smaller units, major thoracic centers nowadays have well-established minimally invasive programs and even perform minor non-intubated procedures on a regular basis. Experience with major niVATS cases still is sparse across Western Europe, and limited to specialized and highly trained centers, where exceptionally complex and often multimorbid patients can safely undergo lung surgery under spontaneous ventilation. Our group pioneered niVATS lobectomy in Germany back in 2018, and since then we tried to spread the technique by means of multidisciplinary Masterclass-courses held at our center, in which the participant's initial reticence to perform niVATS often changed to enthusiasm for the procedure. This in turn led several visiting units to start with their own programs, and some of them even reported their initial experience. This article offers a short historic overview of VATS in general, gives an insight into how niVATS got pioneered in Germany and presents the current state of affairs.

关键词: Video-assisted thoracoscopic surgery (VATS), Non-intubated video-assisted thoracoscopic surgery (niVATS), Lung surgery in Germany, Major lung resection

Lung surgery under spontaneous ventilation (non-intubated video-assisted thoracoscopic surgery, niVATS) picked up a lot of momentum during the past few years. Surgeons and anesthetists alike want to forgo known risks of orotracheal intubation and mechanical ventilation, ranging from local complications, like mucosal injury or even deleterious tracheal laceration and rupture, to increased release of pro-inflammatory cytokines and diaphragmatic dysfunction secondary to muscle relaxation. Despite initial adoption of VATS in Germany having been slow due to a general reticence towards it in smaller units, major thoracic centers nowadays have well-established minimally invasive programs and even perform minor non-intubated procedures on a regular basis. Experience with major niVATS cases still is sparse across Western Europe, and limited to specialized and highly trained centers, where exceptionally complex and often multimorbid patients can safely undergo lung surgery under spontaneous ventilation. Our group pioneered niVATS lobectomy in Germany back in 2018, and since then we tried to spread the technique by means of multidisciplinary Masterclass-courses held at our center, in which the participant's initial reticence to perform niVATS often changed to enthusiasm for the procedure. This in turn led several visiting units to start with their own programs, and some of them even reported their initial experience. This article offers a short historic overview of VATS in general, gives an insight into how niVATS got pioneered in Germany and presents the current state of affairs.

Key words: Video-assisted thoracoscopic surgery (VATS), Non-intubated video-assisted thoracoscopic surgery (niVATS), Lung surgery in Germany, Major lung resection
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[1] Julio Sesma, Sergio Bolufer, Carlos Galvez, Francisco Lirio, Juan José Mafé, Jone Miren Del Campo, Sergio Maroto, Leyre Sebastian, Marta Ortega, Luis Jorge Cerezal. Technical aspects of uniportal VATS lung major resections with bronchovascular reconstruction[J]. 中华胸部外科电子杂志, 2021, 08(04): 209-217.
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