What is the recommended perioperative care plan for patients undergoing a Video-Assisted Thoracoscopic (VAT) procedure for lung conditions?

From the Guidelines

The recommended perioperative care plan for patients undergoing Video-Assisted Thoracoscopic (VAT) procedures for lung conditions should follow an Enhanced Recovery After Surgery (ERAS) protocol, as outlined in the most recent guidelines 1.

Preoperative Care

Preoperatively, patients should undergo thorough assessment including:

• Pulmonary function tests
• Smoking cessation at least 4 weeks before surgery
• Optimization of comorbidities Preoperative medications should include:
• Anxiolytics as needed
• Carbohydrate loading 2-3 hours before surgery unless contraindicated
• Antibiotic prophylaxis with cefazolin 2g IV (or clindamycin 600mg IV for penicillin-allergic patients) should be administered within 60 minutes before incision

Intraoperative Care

Intraoperatively, lung-protective ventilation strategies should be employed with:

• Tidal volumes of 4-6 mL/kg
• PEEP of 5-10 cmH2O Analgesia should include multimodal approaches with:
• Intercostal nerve blocks using bupivacaine 0.25% or ropivacaine 0.2%
• Systemic medications including acetaminophen 1g IV, ketorolac 15-30mg IV, and judicious opioid use

Postoperative Care

Postoperatively, early chest tube removal when drainage is less than 200-300 mL/day and no air leak is present will facilitate mobilization. Pain management should transition to oral medications including:

• Acetaminophen 1000mg every 6 hours
• NSAIDs like ibuprofen 400-600mg every 6 hours
• Opioids as needed Early mobilization within 6 hours of surgery, incentive spirometry every hour while awake, and early oral intake are crucial for reducing complications like atelectasis, pneumonia, and venous thromboembolism. This comprehensive approach reduces hospital length of stay, decreases complication rates, and improves patient satisfaction by addressing the physiological stress response to surgery, as supported by the guidelines 1 and studies on VATS procedures 1.

From the Research

Perioperative Care Plan for VAT Procedure Lung

The recommended perioperative care plan for patients undergoing a Video-Assisted Thoracoscopic (VAT) procedure for lung conditions involves several key considerations:

• Preoperative evaluation and selection of suitable patients for VAT procedure, as emphasized in 2
• Adherence to oncological surgical principles and meticulous technique to minimize complications, as highlighted in 2
• Use of a standardized approach, such as the endoscopic hilar dissection technique, to ensure consistency and safety, as described in 3
• Monitoring for postoperative complications, such as pulmonary complications, and having a plan in place for their management, as discussed in 4

Intraoperative Considerations

Intraoperative considerations for VAT procedure lung include:

• Use of three ports for thoracoscope, endoscopic instruments, and endostapler, as described in 2
• Employment of a utility thoracotomy without rib spreader for major pulmonary resections, as mentioned in 2
• Isolation and separate sectioning of hilar structures in anatomic resections, as highlighted in 2

Postoperative Care

Postoperative care for VAT procedure lung involves:

• Monitoring for postoperative morbidity, such as respiratory complications, and managing them promptly, as discussed in 2, 3, 4
• Use of opioids for pain management, with consideration of the potential for increased need in VATS patients, as noted in 4
• Planning for potential conversion to open surgery, if necessary, to ensure patient safety, as emphasized in 2

Outcomes and Survival

Outcomes and survival for VAT procedure lung have been studied extensively:

• VATS lobectomy has been shown to be a safe and feasible surgical procedure with comparable long-term results to conventional open lobectomy, as demonstrated in 3, 5
• The 5-year overall survival rates for stage I, stage II, and stage III or greater non-small cell lung cancer (NSCLC) have been reported to be 79.1%, 45.5%, and 22.2%, respectively, as noted in 3
• VATS approach to lobectomy has been found to be a beneficial alternative to standard thoracotomy for selected cases of pulmonary lesions, as discussed in 3, 6