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- W4313220549 abstract "Introduction: Air leak after lung surgery is common and can increase chest tube (CT)duration, morbidity/mortality, length of stay (LOS) and costs. Air leaks occur in upwards of 70% of VATS resections and prolonged >3day air leaks (PAL) in upwards of 12%. Resulting prolonged CT duration decreases mobility, increase pain med usage, increase ileus, inhibit deep breaths, increasing atelectasis/pneumonia, increase infection/DVT/PE risk. We compared PAL rates in traditional VATS under general anesthesia vs. AVATS under local with sedation. Methods: Over ten years we have performed over 2600 AVATS for a variety of procedures including lobectomy, segmentectomy, decortications, wedges, esophageal repair/bronchopleural fistula/diaphragm repairs and trauma cases. We compared air leak rates and PAL rate in a subgroup of 762 AVATS lung resections against 268 traditional VATS resections. All cases were performed by same surgeon via 1- 2 port technique. CT duration, opioid usage for pain control (usage of IV or oral opioid >2 doses/24 hours) and length of stay data were compared. Results: Air leak rate (< 3 day) in the 268 traditional VATS resections was 22%, rate of PAL (>3 day) was 6% and two patients developed crepitus requiring reintervention/added CT placement. Opioid requirement until discharge was seen in 68%. LOS was 2.8 days. One UTI and 1 DVT were seen. Analysis of the 762 AVATS found an air leak rate (< 3 day) of 2% and PAL (>3 day) rate was zero. Opioid usage was limited to 2 doses or less in 98%, also minimizing nausea/confusion. Almost all patients (95%) received IV acetaminophen and IV ketorolac. Average CT duration was 23 hours. Only 8 required CT for 2 days. LOS was 1.2 days. AVATS often performed via single incision with 2-level intercostal block and sedation using dexmedetomidine allowed for arousal of the patient at completion of resection while scope still in chest eliciting a cough to visualize any air leak allowing for repair. Avoiding general anesthesia eliminated cough/bucking on extubation that may strain suture/staple lines. Near complete elimination of air leaks allows 12-french catheter use instead of larger tubes minimizing pain and thus opioid usage. There was no DVT/PE, stroke, UTI, pneumonia seen. Conclusions: AVATS has lower air leak/PAL rates and shorter LOS compared to traditional VATS." @default.
- W4313220549 created "2023-01-06" @default.
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- W4313220549 date "2022-12-15" @default.
- W4313220549 modified "2023-09-27" @default.
- W4313220549 title "926: AWAKE VIDEO-ASSISTED THORACIC SURGERY VERSUS STANDARD VATS: COMPARISON OF AIR LEAK RATES/DURATION" @default.
- W4313220549 doi "https://doi.org/10.1097/01.ccm.0000909432.99230.d7" @default.
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