Awake Lung Biopsy for Interstitial Lung Disease

Lung biopsy has become progressively more important to achieve a definitive diagnosis in patients with Interstitial Lung Disease (ILD) who does not exhibit an easily recognizable clinicalradiological pattern.

Surgical biopsy has been accomplished via thoracotomy or Video-Assisted Thoracic Surgery (VATS), which is deemed to offer a lower morbidity, less pain and a shorter hospital stay.

Unfortunately, many ILD patients are considered at high-risk for surgical biopsy due to the need for general anesthesia, which can be poorly tolerated, particularly in patients with compromised respiratory function, pulmonary hypertension and/or immune-suppression.In order to avoid these generalanesthesia- related adverse effects, we have developed a VATS biopsy approach that is performed under thoracic epidural or local anesthesia in awake patients with spontaneous ventilation.

We believe that the introduction of awake VATS biopsy might lead to an easier acceptance of the surgical procedure by both patients and pneumologists and could widen the number of precise pathologic diagnoses, eventually resulting in more targeted therapeutic regimens.

Keywords: Interstitial lung disease, VATS, awake thoracic surgery, lung biopsy, epidural anesthesia.