Innovation in awake VATS

We are pleased to introduce you this issue devoted to awake thoracic surgery.

Undoubtedly, video-assisted thoracic surgery (VATS) is the most common innovation in the field of thoracic surgery of the last 20 years. Although the operations performed by VATS are equivalent to those performed in open surgery, modifications of the technique include the number and position of the ports, and type of anesthesia. In this context, we, expert thoracic surgeons, are always looking for a better way to operate patients who cannot receive general anesthesia.

The evolution of VATS from multi to uniportal access paralleled to awake non-general non-intubated anesthesia permits nowadays successfully minor and major thoracic procedures. As a whole, these inseparable technological and surgical progresses engender more confidence into the patients, especially older, who are keener to accept the proposed awake thoracic procedure. Though surgeons who want embarking in awake thoracic surgery are looking for consistent data in favor of this approach, there are very few data and most published experiences raise questions instead of giving answers. Hence, this special issue, which includes also outstanding videos, will serve to the modern and next generation of surgeons as a milestone from where to build their knowledge and experience.

We would like to thank our expert colleagues who share with us the importance of disseminating their experience, and the awake solutions for difficult patients who cannot receive general anesthesia. Finally, we also would like to thank VATS journal not only for letting us organize and finish this special issue but also for the outstanding work done by all the staff.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Video-Assisted Thoracic Surgery for the series “Non-intubated Thoracic Surgery”. The article did not undergo external peer review.

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/vats.2018.01.05). The series “Non-intubated Thoracic Surgery” was commissioned by the editorial office without any funding or sponsorship. TCM served as the unpaid Guest Editor of the series. MM served as the unpaid Guest Editor of the series and serves as an unpaid editorial board member of Video-Assisted Thoracic Surgery from Mar 2017 to May 2019. The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

Tommaso Claudio Mineo

Marcello Migliore