Minimally invasive thoracic surgery has been demonstrated to achieve superior outcomes for patients with basic and complex thoracic conditions. Advantages of thoracoscopic surgery include less postoperative pain, faster return to full activity, preserved pulmonary function, shorter length of hospitalization, reduced inflammatory response, and a lower rate of postoperative complications. With increasing experience, the boundaries of thoracoscopy have dissolved and the strategies of minimally invasive surgery have expanded. In particular, the concept of awake thoracic surgery has emerged as an important novel strategy to optimize the advantages of minimally invasive surgery.
Awake thoracoscopic surgery encompasses the advantages of limiting the invasiveness of both anesthesia and surgery, which may magnify the known benefits of minimally invasive thoracic surgery. Although initially applicable to only the most basic procedures, awake thoracoscopic strategies are currently used to successfully complete advanced procedures as well, including lung volume reduction, decortication, and thymectomy. Whereas the recognition of the advantages of thoracoscopic surgery has been slow in evolution, it is hoped that the strategy of awake thoracoscopic surgery is more promptly understood and embraced. This monograph by Dr. Eugenio Pompeo outlines both the theoretical and proved advantages of the anesthetic and surgical techniques that are employed in awake surgery. In addition, the results of a spectrum of awake thoracoscopic surgery, including both basic and complex procedures, are described in detail by the recognized experts in the field. Awake thoracic surgery will eventually be included in thoracic surgery training programs, but until then the practicing thoracic surgeon should learn this important strategy, and this monograph represents a comprehensive and valuable summary.
Thomas A. D’Amico
Professor of Surgery
Duke University Medical Center
Durham, North Carolina