Awake Operative Videothoracoscopic Pulmonary Resections

General anesthesia with one-lung ventilation is considered mandatory for videothoracoscopic pulmonary resection but has some adverse effects, which can contribute to the overall procedure-related morbidity. This finding has led to the concept of a more physiologic and globally less-invasive approach, entailing awake thoracoscopic pulmonary resection under sole epidural anesthesia. Indications, although still investigational, include resection of undetermined solitary pulmonary nodules, pulmonary metastases, and non-small cell lung cancer in high-risk patients. Preliminary results have been highly satisfactory, showing that this modality is feasible, safe, and effective. Furthermore, some evidence seems to show that this patient-friendly approach could be more cost-effective, allow a more rapid recovery, and require reduced hospitalization. Further investigation and larger prospective studies will eventually confirm the real effectiveness and proper indications of awake videothoracoscopic pulmonary resections.