P-145INTER-INSTITUTIONAL REPRODUCIBILITY OF NONINTUBATED THORACOSCOPIC SURGERY WITH ADOPTION OF A TECHNICAL EQUIPOISE STRATEGY

Abstract

Objectives: Aim of this study was to investigate reproducibility of nonintubated video-assisted thoracic surgery (NIVATS) performed under spontaneous ventilation in experienced (Centre A) and non-experienced (Centre B) University Institutions following adoption of a strategy aimed at achieving technical equipoise standards. Methods: Between April and December 2016 a joint NIVATS programme was started between 2 university institutions, one in Italy (Centre A) and one in Israel (Centre B) according to the following strategy: 1) Theoretical and practical multidisciplinary tutoring performed on-site with recognized experts in the field to pursue technical equipoise standards. 2) Real-time exchange of data and images by web and smartphone facilities to optimize management of controversial issues. 3) Prospective collection of standardized data in a common database. 4) Comparative assessment of results including a propensity score matching analysis to test the inter-Institutional reproducibility of outcomes. Results: Overall, 60 NIVATS procedures have been included in the analysis, 26 from Centre B operated on during the study period, and 34 from centre A drawn through propensity score matching. Type of surgical procedures included pleural biopsy with or without talc pleurodesis (n = 22), pulmonary wedge resection (n = 20), lung volume reduction for severe emphysema (n = 14), pleural decortication (n = 2), pericardial window (n =2). The 2 cohorts were well matched for age, type of anaesthesia, type of surgical procedure and associated comorbidity. At comparative (Centre A vs B) analysis, mean operative time differed significantly (33±10 min vs 45±15 min, P < 0.001) whereas there was no difference in technical feasibility (1.97±0.2 vs 1.96±0.2, P=0.85), mortality (0), morbidity (2 vs 3, P=0.64), patient's satisfaction with the anaesthesia (0.97±0.2 vs 0.92±0.3, P=0.41), and hospital stay (4.1±4 days vs 5.4±8 days, P=0.45). Conclusions: The current study suggests that satisfactory and comparable results with no mortality and low morbidity can be achieved by NIVATS both in experienced and non-experienced institutions following adoption of a multidisciplinary technical equipoise strategy.