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Journal of Cardiothoracic Surgery

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Open Access 01-12-2021 | Pleural Effusion | Research article

Uniportal VATS pleural biopsy in the diagnosis of exudative pleural effusion: awake or intubated?

Authors: Mertol Gokce, Bulent Altinsoy, Ozcan Piskin, Burak Bahadir

Published in: Journal of Cardiothoracic Surgery | Issue 1/2021

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.

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Title: Uniportal VATS pleural biopsy in the diagnosis of exudative pleural effusion: awake or intubated?
Authors: Mertol Gokce
Bulent Altinsoy
Ozcan Piskin
Burak Bahadir
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Pleural Effusion
Local Anesthesia in Dentistry
General Anesthesia
Published in: Journal of Cardiothoracic Surgery / Issue 1/2021
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-021-01461-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Uniportal VATS pleural biopsy in the diagnosis of exudative pleural effusion: awake or intubated?

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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