Uniportal VATS pleural biopsy in the diagnosis of exudative pleural effusion: awake or intubated?
Abstract Background The aim of this study is to compare the diagnostic efficacy and safety of video-assisted thoracoscopic surgery (VATS) with awake VATS (AVATS) pleural biopsy in undiagnosed exudative pleural effusions. Methods The diagnostic efficacy of pleural biopsy by uniportal VATS under gener...
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doaj-ec8a1f85809a4e01910bb486f9ae954f2021-04-25T11:08:03ZengBMCJournal of Cardiothoracic Surgery1749-80902021-04-011611910.1186/s13019-021-01461-7Uniportal VATS pleural biopsy in the diagnosis of exudative pleural effusion: awake or intubated?Mertol Gokce0Bulent Altinsoy1Ozcan Piskin2Burak Bahadir3Department of Thoracic Surgery, Bulent Ecevit University Faculty of MedicineDepartment of Pulmonary Medicine, Bulent Ecevit University Faculty of MedicineDepartment of Anesthesiology and Reanimation, Bulent Ecevit University Faculty of MedicineDepartment of Pathology, Bulent Ecevit University Faculty of MedicineAbstract Background The aim of this study is to compare the diagnostic efficacy and safety of video-assisted thoracoscopic surgery (VATS) with awake VATS (AVATS) pleural biopsy in undiagnosed exudative pleural effusions. Methods The diagnostic efficacy of pleural biopsy by uniportal VATS under general anesthesia or AVATS under local anesthesia and sedation performed by the same surgeon in patients with undiagnosed exudative pleural effusion between 2007 and 2020 were retrospectively evaluated. Test sensitivity, specificity, positive predictive value and negative predictive value were compared as well as age, gender, comorbidities, procedure safety, additional pleural-based interventions, duration time of operation and length of hospital stay. Results Of 154 patients with undiagnosed exudative pleural effusion, 113 (73.37%) underwent pleural biopsy and drainage with VATS, while 41 (26.62%) underwent AVATS pleural biopsy. Sensitivity, specificity, positive predictive value and negative predictive value were 92, 100, 100, and 85.71% for VATS, and 83.3, 100, 100, and 78.9% for AVATS, respectively. There was no significant difference in diagnostic test performance between the groups, (p = 0.219). There was no difference in the rate of complications [15 VATS (13.3) versus 4 AVATS (9.8%), p = 0.557]. Considering additional pleural-based interventions, while pleural decortication was performed in 13 (11.5%) cases in the VATS group, no pleural decortication was performed in AVATS group, (p = 0.021). AVATS group was associated with shorter duration time of operation than VATS (22.17 + 6.57 min. Versus 51.93 + 8.85 min., p < 0.001). Length of hospital stay was relatively shorter in AVATS but this was not statistically significant different (p = 0.063). Conclusions Our study revealed that uniportal AVATS pleural biopsy has a similar diagnostic efficacy and safety profile with VATS in the diagnosis and treatment of patients with undiagnosed pleural effusion who have a high risk of general anesthesia due to advanced age and comorbidities. Accordingly, uniportal AVATS pleural biopsy may be considered in the diagnosis and treatment of all exudative undiagnosed pleural effusions.https://doi.org/10.1186/s13019-021-01461-7AwakeLocal anesthesiaPleural effusionVideo-assisted thoracoscopic surgery |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Mertol Gokce Bulent Altinsoy Ozcan Piskin Burak Bahadir |
spellingShingle |
Mertol Gokce Bulent Altinsoy Ozcan Piskin Burak Bahadir Uniportal VATS pleural biopsy in the diagnosis of exudative pleural effusion: awake or intubated? Journal of Cardiothoracic Surgery Awake Local anesthesia Pleural effusion Video-assisted thoracoscopic surgery |
author_facet |
Mertol Gokce Bulent Altinsoy Ozcan Piskin Burak Bahadir |
author_sort |
Mertol Gokce |
title |
Uniportal VATS pleural biopsy in the diagnosis of exudative pleural effusion: awake or intubated? |
title_short |
Uniportal VATS pleural biopsy in the diagnosis of exudative pleural effusion: awake or intubated? |
title_full |
Uniportal VATS pleural biopsy in the diagnosis of exudative pleural effusion: awake or intubated? |
title_fullStr |
Uniportal VATS pleural biopsy in the diagnosis of exudative pleural effusion: awake or intubated? |
title_full_unstemmed |
Uniportal VATS pleural biopsy in the diagnosis of exudative pleural effusion: awake or intubated? |
title_sort |
uniportal vats pleural biopsy in the diagnosis of exudative pleural effusion: awake or intubated? |
publisher |
BMC |
series |
Journal of Cardiothoracic Surgery |
issn |
1749-8090 |
publishDate |
2021-04-01 |
description |
Abstract Background The aim of this study is to compare the diagnostic efficacy and safety of video-assisted thoracoscopic surgery (VATS) with awake VATS (AVATS) pleural biopsy in undiagnosed exudative pleural effusions. Methods The diagnostic efficacy of pleural biopsy by uniportal VATS under general anesthesia or AVATS under local anesthesia and sedation performed by the same surgeon in patients with undiagnosed exudative pleural effusion between 2007 and 2020 were retrospectively evaluated. Test sensitivity, specificity, positive predictive value and negative predictive value were compared as well as age, gender, comorbidities, procedure safety, additional pleural-based interventions, duration time of operation and length of hospital stay. Results Of 154 patients with undiagnosed exudative pleural effusion, 113 (73.37%) underwent pleural biopsy and drainage with VATS, while 41 (26.62%) underwent AVATS pleural biopsy. Sensitivity, specificity, positive predictive value and negative predictive value were 92, 100, 100, and 85.71% for VATS, and 83.3, 100, 100, and 78.9% for AVATS, respectively. There was no significant difference in diagnostic test performance between the groups, (p = 0.219). There was no difference in the rate of complications [15 VATS (13.3) versus 4 AVATS (9.8%), p = 0.557]. Considering additional pleural-based interventions, while pleural decortication was performed in 13 (11.5%) cases in the VATS group, no pleural decortication was performed in AVATS group, (p = 0.021). AVATS group was associated with shorter duration time of operation than VATS (22.17 + 6.57 min. Versus 51.93 + 8.85 min., p < 0.001). Length of hospital stay was relatively shorter in AVATS but this was not statistically significant different (p = 0.063). Conclusions Our study revealed that uniportal AVATS pleural biopsy has a similar diagnostic efficacy and safety profile with VATS in the diagnosis and treatment of patients with undiagnosed pleural effusion who have a high risk of general anesthesia due to advanced age and comorbidities. Accordingly, uniportal AVATS pleural biopsy may be considered in the diagnosis and treatment of all exudative undiagnosed pleural effusions. |
topic |
Awake Local anesthesia Pleural effusion Video-assisted thoracoscopic surgery |
url |
https://doi.org/10.1186/s13019-021-01461-7 |
work_keys_str_mv |
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