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The objective: to implement the non-intubated treatment of pneumothorax in women and its inclusion in the protocol of Enhanced Recovery After Surgery (ERAS). Materials and methods. Surgical treatment using non-intubated video-assisted thoracic surgery (NIVATS) in 30 women with an average age of 38.56 ± 11.32 years (18-69 years) with spontaneous pneumothorax was analyzed. Most of the patients had a first episode of pneumothorax (90%), 3 people had a recurrent episode. All patients were operated by the method of non-intubated uniportal video-assisted thoracic surgery (NI-UVATS) with thoracic epidural anesthesia (TEA) as the main method of analgesia in the postoperative period. The average time to surgery was 1.5 days (0-5 days). Pathohistological studies confirmed the etiology of pneumothorax: bullous disease, thoracic endometriosis. Patients with confirmed thoracic endometriosis were referred to a gynecologist for consultation. The observation period was 48 months. Results. All patients underwent operative treatment and were satisfied with the NIVATS operation. The level of pain intensity according to the visual analogue scale was 1-2 points. The recurrence rate after NI-VATS surgery was 6.7% (2 patients) with confirmed thoracic endometriosis during the use of combined estrogen and progesterone hormone pills, the recurrences occurred after stop of hormonal treatment. Conclusions. Non-intubated video-assisted thoracic surgery for spontaneous pneumothorax in women can be considered a safe and effective treatment and as part of enhanced recovery after surgery (ERAS). Long-term follow-up and further clinical studies are needed to confirm the benefits of the proposed approach. [ABSTRACT FROM AUTHOR]

The aim of our clinical study was to justify and implement non-intubated video assisted thoracic surgery as a part of enhanced recovery after surgery pathway in treatment of spontaneous pneumothorax. Data of 150 patients who underwent surgical treatment were retrospectively analyzed. Among them group 1 of 75 patients underwent video-assisted thoracoscopic surgery (VATS) and group 2 of 75 patients underwent non-intubated VATS surgical treatment. All patients underwent atypical resection of the lung and pleural abrasion, diaphragm augmentation with mesh if diaphragm endometriosis was suspected. The perioperative data, short-term outcomes and recurrence rates of these two groups were compared. The two groups had comparable demographic, perioperative investigations, fluid infusions during surgery, the volume of surgery intraoperatively, blood loss, time for chest drain removal, length of stay in the hospital and the rate of complications. There were no conversions to thoracotomy or intubated general anaesthesia, no mortality. The peak end-tidal carbon dioxide was significantly higher in the non-intubated group than in the intubated group (mean: 48±8.6 vs 34±6.2 mmHg, ɪ<0.001). The mean follow-up was 20.2±3.9 months in the non-intubated group and 24.7±4.2 months in the intubated group (p>0.05). Chest tube duration was 4.11 days in group 1 and 3.76 days in group 2. The recurrence rate of pneumothorax after surgery was 4% in both groups. Nnon-intubated video-assisted thoracic surgery for spontaneous pneumothorax could be considered a feasible, safe and effective method of treatment, even with mesh diaphragm augmentation, in cases of catamenial pneumothorax and can be a part of Enhanced Recovery After Surgery pathway. Continious follow-up and additional clinical investigations are supposed to validate the profits of the suggested approach. [ABSTRACT FROM AUTHOR]