MINIMALLY INVASIVE APPROACH FOR PNEUMONECTOMY CULMINATING IN AN OUTPATIENT PROCEDURE

Study objective: To establish the effects of the use of a clinical pat hway that includes a minimally invasive access among patients undergoi ng pneumonectomy. Design: Prospective study from February to December of 1997, Setting: A community hospital. Patients: Five consecutive pat ients with a mean age of 60 years (range 43 to 74 years) with lung mal ignancies who required pneumonectomy. Interventions: Clinical pathway based on patient education, a meticulous minimally invasive operation (oblique muscle-sparing minithoracotomy), intercostal nerve cryoanalge sia, and a quick postoperative resumption of physical activity. Result s: All five patients were extubated in the operating room. They all ha d unrestricted shoulder mobility in the recovery room, and none requir ed intravenous narcotics after leaving this unit. All patients were ou t of bed the day of the operation, and one patient was able to ambulat e freely only a few hours after the procedure. Four patients were disc harged the day after surgery, and one patient was discharged the same day of the operation. None required readmission related to the procedu re. Conclusion: This initial experience seems to indicate that the app lication of this clinical pathway in patients undergoing pneumonectomy greatly accelerates their recovery and, for a select group of patient s, converts it into an outpatient procedure.