Perioperative Challenges and Benefits of Awake Thoracic Surgery: Insights From Non-Intubated Vats Pleural Biopsy

Abstract

Background: Non-intubated Video-Assisted Thoracoscopic Surgery (VATS) pleural biopsy is a valuable option for patients with comorbidities, avoiding general anesthesia and reducing perioperative risks. Data from low-resource settings are scarce. The aim of the study is to assess perioperative challenges, diagnostic yield, and short-term outcomes of awake non-intubated VATS pleural biopsy in Bangladesh.

Materials and methods: A prospective study was conducted at the National Institute of Diseases of the Chest and Hospital, Dhaka, from January 2022 to June 2023. Thirty adults with exudative pleural effusion underwent non-intubated VATS pleural biopsy under local anesthesia with sedation. Perioperative events, histopathology, and recovery outcomes were analyzed using SPSS v 26.0.

Results: All patients (n=30) completed the procedure; 6.7% required conversion to general anesthesia. Complications were minimal (Desaturation, 6.7%, coughing: 10%). Mean operative time was 38.6±5.8 minutes. Recovery was early: ambulation in 5.4±2.2 hours and oral intake in 3.8±1.5 hours. Histopathology revealed tuberculous pleuritis (30%) mesothelioma (23.3%) and metastatic carcinoma (20%). Mean hospital stay was 5.3±1.1 days.  

Conclusion: Awake non-intubated VATS pleural biopsy is safe, effective and associated with rapid recovery and minimal complications. It represents a practical strategy for resource-limited settings where anesthesia risks must be minimized.

JCMCTA 2026 ; 37 (1) : 73-78