Team training for nonintubated thoracic surgery

Nonintubated thoracic surgery needs a specific formation of a well-trained and close-knit staff, including surgeons, anesthesiologists, scrub nurses, operating room, and floor assistants. Operation requires advanced surgical skill compared with normal video-assisted thoracic surgery due to the presence of breathing or cough, patient anxiety, intolerance, or hypercapnia. Dry laboratory and wet laboratory training may be of scant value due to the impossibility of reproducing lung movements, whereas visiting a high-volume center or hosting an experienced team would be of greater value. Communication with patients, preoperatively and intraoperatively, and among the surgical team is pivotal and should follow a precise plan, reassuring the subjects, inciting them when necessary, with avoiding of impatience and anxiety.