Diagnostic value of awake vats biopsy in malignant pleural effusion

The aim of our study was to demonstrate the diagnostic value of awake Video Assisted Thoracic Surgery for the diagnosis and treatment of patients with pleural effusion. We retrospectively evaluated 167 patients with pleural effusion who underwent pleural biopsy with Video Assisted Thoracic Surgery in the Department of Thoracic Surgery, Faculty of Medicine, Trakya University, between 15/02/2010 and 15/02/2023. Patients were divided into two main groups. Group I (n:59) consisted of patients intubated under general anesthesia and Group II (n:108) consisted of awake non-intubated patients. There was no significant difference between the two groups when age, gender, comorbid diseases and operation time were evaluated (p>0.05). The duration of anesthesia was significantly less in Group II (p<0.001). The mean number of pleural biopsy sites was significantly higher in Group I (p=0.005). When all postoperative diagnoses and malignant results were evaluated, there was no significant difference between the groups (p=0.208, p=0.256, respectively). When the length of hospitalization was analyzed, it was determined that patients in Group I were hospitalized longer (p=0.022). The time to start postoperative oral intake and mobilization was higher in Group I (p<0.001). There was no significant difference between the groups in terms of complication rates (p=0.569). Subcutaneous emphysema, which developed with a rate of 8.33% in Group II, was not observed in Group I, and a significant difference was observed in this respect (p=0.027). There was no significant difference between the groups in terms of prolonged air leakage, pneumonia, wound site infection and respiratory failure (p=0.849, p=0.225, p=0.127, p=0.540, respectively). Awake, non-intubated Video Assisted Thoracic Surgery can be safely performed in the diagnosis and treatment of undiagnosed pleural effusions. Awake non-intubated Video Assisted Thoracic Surgery has the advantages of short anesthesia time, rapid initiation of oral intake and rapid mobilization, and absence of intubation-related risks. Randomized controlled trials with larger case series are needed for this procedure to become the gold standard.