Minimally Invasive Approach for Pneumonectomy Culminating in An Outpatient Procedure*

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Abstract

Study objective

To establish the effects of the use of a clinical pathway that includes a minimally invasive access among patients undergoing pneumonectomy.

Design

Prospective study from February to December of 1997.

Setting

A community hospital.

Patients

Five consecutive patients with a mean age of 60 years (range 43 to 74 years) with lung malignancies who required pneumonectomy.

Interventions

Clinical pathway based on patient education, a meticulous minimally invasive operation (oblique muscle-sparing minithoracotomy), intercostal nerve cryoanalgesia, and a quick postoperative resumption of physical activity.

Results

All five patients were extubated in the operating room. They all had unrestricted shoulder mobility in the recovery room, and none required intravenous narcotics after leaving this unit. All patients were out of bed the day of the operation, and one patient was able to ambulate freely only a few hours after the procedure. Four patients were discharged the day after surgery, and one patient was discharged the same day of the operation. None required readmission related to the procedure.

Conclusion

This initial experience seems to indicate that the application of this clinical pathway in patients undergoing pneumonectomy greatly accelerates their recovery and, for a select group of patients, converts it into an outpatient procedure. (CHEST 1998; 114:1454-1458)

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