***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES Advantages of thoracoscopic lobectomy include less postoperative pain , shorter hospitalization , and improved delivery of adjuvant chemotherapy . The incidence of postoperative complications has not been thoroughly assessed . This study analyzes morbidity after lobectomy to compare the thoracoscopic approach and thoracotomy . METHODS By using a prospect i ve data base , the outcomes of patients who underwent lobectomy from 1999 - 2009 were analyzed with respect to postoperative complications . Propensity-matched groups were analyzed based on preoperative variables and stage . RESULTS Of the 1079 patients in the study , 697 underwent thoracoscopic lobectomy , and 382 underwent lobectomy by means of thoracotomy .  In the overall analysis thoracoscopic lobectomy was associated with a lower incidence of atrial fibrillation ( P = .01 ) , atelectasis ( P = .0001 ) , prolonged air leak ( P = .0004 ) , transfusion ( P = .0001 ) , pneumonia ( P = .001 ) , sepsis ( P = .008 ) , renal failure ( P = .003 ) , and death ( P = .003 ) . In the propensity-matched analysis based on preoperative variables , when comparing 284 patients in each group , 196 ( 69 % ) patients who underwent thoracoscopic lobectomy had no complications versus 144 ( 51 % ) patients who underwent thoracotomy ( P = .0001 ) . In addition , thoracoscopic lobectomy was associated with a lower incidence of atrial fibrillation ( 13 % vs 21 % , P = .01 ) , less atelectasis ( 5 % vs 12 % , P = .006 ) , fewer prolonged air leaks ( 13 % vs 19 % , P = .05 ) , fewer transfusions ( 4 % vs 13 % , P = .002 ) , less pneumonia ( 5 % vs 10 % , P = .05 ) , less renal failure ( 1.4 % vs 5 % , P = .02 ) , shorter chest tube duration ( median of 3 vs 4 days , P < .0001 ) , and shorter length of hospital stay ( median of 4 vs 5 days , P < .0001 ) . CONCLUSIONS Thoracoscopic lobectomy is associated with a lower incidence of major complications , including atrial fibrillation , compared with lobectomy by means of thoracotomy . The underlying factors responsible for this advantage should be analyzed to improve the safety and outcomes of other thoracic procedures OBJECTIVE We assessed in a r and omized study the feasibility and efficacy of awake video-assisted thoracoscopic bullectomy with pleural abrasion to treat spontaneous pneumothorax . METHODS Between January 2001 and June 2005 , a total of 43 patients with primary spontaneous pneumothorax were r and omly assigned by computer to undergo video-assisted thoracoscopic bullectomy and pleural abrasion under sole thoracic epidural anesthesia or general anesthesia with single-lung ventilation ( control group ) . Primary outcome measures included technical feasibility and patient satisfaction with anesthesia as scored into 4 grade s ( from 1 , unsatisfactory , to 4 , excellent ) . Secondary outcome measures included global operating room time , assessment of thoracic pain by visual analog pain scale , number of nursing care calls , hospital stay , and recurrences within 12 months . RESULTS In the awake group , technical feasibility was scored as excellent , good , and satisfactory in 8 , 7 , and 6 patients , respectively . Intergroup comparisons ( awake versus control ) showed that global operating room time ( 78.0 + /- 20.0 vs 105.0 + /- 15.0 minutes , P < .0001 ) , perioperative visual analog pain scale score ( 2.0 + /- 3.0 vs 3.5 + /- 2.0 , P = .005 ) , nursing care calls ( 2.0 + /- 1 vs 3.0 + /- 3.0 , P = .017 ) , hospital stay ( 2.0 + /- 1.0 days vs 3.0 + /- 1.0 days , P < .0001 ) , and overall costs ( 2540 euros + /- 352 euros vs 3550 euros + /- 435 euros , P < .0001 ) were significantly better in the awake group . In the awake group , 5 patients ( 23.8 % ) could be discharged within the first 24 postoperative hours . One patient in the awake group and 2 patients in the control group had recurrences within 12 months ( difference not significant ) . CONCLUSION In our study , awake video-assisted thoracoscopic bullectomy with pleural abrasion proved easily feasible and result ed in shorter hospital stays and reduced procedure-related costs while providing equivalent outcome to procedures performed under general anesthesia Objective : Advantages of thoracoscopic lobectomy for early stage non-small cell lung cancer ( NSCLC ) , as compared with lobectomy by conventional thoracotomy , include less postoperative pain and shorter length of hospitalization . The outcomes after thoracoscopic lobectomy in patients with more complex pulmonary conditions are analyzed to determine safety , efficacy , and versatility . Methods : A prospect i ve data base of 500 consecutive patients who underwent thoracoscopic lobectomy between June 1999 and January 2006 was queried . Demographic , histopathologic , perioperative , and outcome variables were assessed using st and ard descriptive statistics and Kaplan-Meier survival analyses . Results : Thoracoscopic lobectomy was successfully performed in 492 patients ( conversion rate , 1.6 % ) . Pathologic analysis included primary NSCLC in 416 patients ( 83.2 % ) , central ly located secondary pulmonary malignancy in 37 patients ( 7.4 % ) , and a variety of benign conditions in 45 patients ( 9 % ) . Among the 416 patients with NSCLC , pathologic analysis demonstrated stage I in 330 patients ( 55.3 % ) , stage II in 40 patients ( 9.6 % ) , and stage III or greater NSCLC in 44 patients ( 10.6 % ) . The operative and perioperative ( 30-day ) mortality was 0 % and 1 % , respectively . The overall 2-year survival rate for the entire cohort was 80 % , and the 2-year overall survival rates for stage I NSCLC , stage II or greater NSCLC , secondary pulmonary malignancy , and granulomatous disease patients were 85 % , 77 % , 73 % , and 89 % , respectively . Conclusions : Thoracoscopic lobectomy is applicable to a spectrum of malignant and benign pulmonary disease and is associated with a low perioperative morbidity and mortality rate . Survival rates are comparable to those for lobectomy with thoracotomy BACKGROUND General anesthesia with single-lung ventilation is considered m and atory for thoracoscopic pulmonary resection . We assessed in a r and omized study the feasibility and results of awake thoracoscopic resection of solitary pulmonary nodules . METHODS Between March 2001 and February 2003 , 60 patients were r and omized into two 30- patients arms : a general anesthesia arm entailing double-lumen intubation and thoracic epidural anesthesia ( control group ) ; and an awake arm entailing sole thoracic epidural anesthesia at T4-T5 ( awake group ) .  Anesthesia time ; operative time ; global operating room time ; patient satisfaction with the anesthesia and technical feasibility scored into 4 grade s ( from 1 = poor to 4 = excellent ) ; visual analog pain score ( VAS ) , nursing care ( number of patient calls per day ) , 24 hours changes in arterial oxygenation ( DeltaPaO2 ) , and hospital stay were assessed . RESULTS There was no mortality . There was no difference in technical feasibility between the groups although 2 patients in the awake group required conversion to thoracotomy due to severe adhesions . Other 2 patients in each group required conversion due to unexpected lung cancer requiring lobectomy . Comparisons of awake versus control group results showed that in the awake group , anesthesia satisfaction score was greater ( 4 vs 3 , p = 0.04 ) , whereas DeltaPaO2 ( -3 mm Hg vs -6.5 mm Hg , p = 0.002 ) ; nursing care ( 2.5 calls per day vs 4 calls per day , p = 0.0001 ) , and hospital stay ( 2 days vs 3 days , p = 0.02 ) were significantly reduced . CONCLUSIONS In our study , awake thoracoscopic resection of solitary pulmonary nodules proved safely feasible . It result ed in better patient satisfaction , less nursing care and shorter in-hospital stay than procedures performed under general anesthesia OBJECTIVE ( S ) Less general anesthetic is required in patients with regional blocks than in those without , as assessed through commonly used anesthesia monitoring parameters such as blood pressure , heart rate , and bispectral index ( BIS ) . Although intraoperative regional anesthesia has become more widely adopted , few studies have confirmed or monitored its anesthetic-sparing effects . Using recent reports of nonintubated video-assisted thoracoscopic surgery ( VATS ) by BIS-targeted propofol infusion and intraoperative multilevel thoracoscopic intercostal nerve blocks ( TINBs ) , this retrospective study investigated whether the anesthetic-sparing effect can be realized by reducing the effect-site concentration ( Ce ) to the targeted BIS level or by reducing the blood pressure at the onset of regional blocks . METHODS A retrospective study of a prospect ively collected case series of non-intubated VATS . RESULTS Data on 56 adult patients who underwent nonintubated VATS were collected and analyzed . The mean operative time was 121 ± 32 minutes . BIS levels before and after one-lung ventilation/TINBs and surgery were 48 % ± 11 % and 47 % ± 12 % , respectively . The Ce of propofol infusion decreased significantly from 3.4 ± 0.8 μg/mL to 3.0 ± 0.7 μg/mL ( p < 0.01 ) after surgery with TINBs . Blood pressure did not change significantly , whereas the heart rate increased moderately but significantly ( 77 ± 14 beats/minute to 82 ± 15 beats/minute , p < 0.01 ) . CONCLUSION With comparable BIS and blood pressure in the subsequent surgical procedure , the adequacy of anesthesia and the anesthetic component provided by intraoperative TINBs and vagal nerve could be monitored adequately . The anesthetic-sparing effect of intraoperative nerve blocks can be realized when the Ce of propofol infusion was reduced to the target BIS level OBJECTIVE To assess the feasibility and safety of thoracoscopic bulla resection under laryngeal mask anesthesia with low tidal volume high-frequency lung ventilation . METHODS Sixty patients with pulmonary bulla were r and omized into two groups ( n=30 ) to undergo video-assisted thoracoscopic surgery ( VATS ) for bulla resection with laryngeal mask anesthesia and high-frequency low tidal volume lung ventilation general anesthesia and or with intubation anesthesia and one-lung ventilation through double-lumen endotracheal intubation . RESULTS No significant differences were found in anesthesia time , surgery time , intraoperative lowest SpO2 , intraoperative highest PetCO2 , operative field , anesthetic effects , or blood loss between the two groups . The post-operative WBC and NEU% showed significantly smaller increments in the mask anesthesia group than in the intubation group , and the postoperative awake time , initial eating time , ambulation time , in-hospital stay , and drainage time were significantly shortened in the former group with also lower incidences of gastrointestinal reactions , throat discomfort and hoarseness . CONCLUSION Thoracoscopic bulla resection under laryngeal mask anesthesia with low tidal volume high-frequency lung ventilation is safe and feasible and results in better patient satisfaction and shorter in-hospital stay than procedures performed under intubation anesthesia with one-lung ventilation OBJECTIVE In a prospect i ve non-r and omized study , we compared results and costs of  non-resectional lung volume reduction surgery ( LVRS ) performed through awake or non-awake anesthesia  that was freely chosen by recruited patients . METHOD Non-resectional LVRS was performed by epidural anesthesia  in 41 patients ( awake group ) and by general anesthesia in 19 patients ( non-awake group ) . Perioperative outcome included analysis of oxygenation ( PaO(2)/FiO(2 ) ) at fixed time points and global time spent in the operating room ( anesthesia plus surgery plus weaning plus recovery times ) . Costs were evaluated at discharge . Forced expiratory volume in 1s ( FEV(1 ) ) , plethysmographic residual volume ( RV(plet ) ) and maximal incremental treadmill test ( MITT ) score were assessed preoperatively and every 6 months , postoperatively . RESULTS Perioperative outcome was better in the awake group with better 
    Output:
    
Conclusions NIVATS is a safe , efficient and feasible technique for thoracic surgery and may be a better alternative procedure owing to its advantage in reducing postoperative complications rate , hospital stay , and chest pain