An "unusual" minimally invasive surgery for pulmonary nodules was performed in the thoracic surgery room of Beijing Chest Hospital affiliated with Capital Medical University. Unusually, this patient did not insert the "three tubes" (double lumen bronchial tube, thoracic drainage tube, urinary catheter), and only underwent surgery under shallow anesthesia and spontaneous breathing using techniques such as laryngeal mask airway ventilation combined with nerve block. About 20 minutes later, the surgery was successfully completed and the patient quickly regained consciousness. From the traditional large opening surgery of "whole body intubation" to "Tubeless minimally invasive" (Tubeless VATS), this pioneering technique by Professor He Jianxing, director of the National Respiratory Medicine Center at the First Affiliated Hospital of Guangzhou Medical University, a Chinese thoracic surgery expert, has led the innovation of thoracic surgery medical technology, helping patients bid farewell to the pain of "whole body intubation" and achieve faster recovery, shorter hospitalization, and better experience. As a tertiary hospital specializing in the diagnosis and treatment of chest diseases, Beijing Chest Hospital has also taken the lead in introducing this innovative technology. The hospital continues to promote the development strategy of 'strong specialization and comprehensive refinement', building a patient-centered and multidisciplinary supported diagnosis and treatment platform, allowing more patients to enjoy high-quality medical services that are precise, minimally invasive, and fast to recover. "Li Xiaobei, Deputy Secretary of the Party Committee and President of Beijing Chest Hospital, said that to carry out unmanaged surgery, multidisciplinary collaborative services such as thoracic surgery, anesthesia, critical care medicine, laboratory, ultrasound, pathology, etc. are needed to 'safeguard' patients. From "three management" to "three no", behind the technological innovation lies a leap in surgical philosophy. Liu Zhidong, director of the Department of Thoracic Surgery at Beijing Chest Hospital, stated that non management technology is not only a technological innovation, but also a significant leap in surgical philosophy, reflecting the true implementation of patient-centered surgical philosophy. Tracheal technique is an important component of Rapid Recovery Surgery (ERAS), and its implementation relies on two core advances: first, the improvement of anesthesia technology, which uses laryngeal mask airway instead of traditional endotracheal intubation to avoid irritation to the airway mucosa and reduce the use of muscle relaxants, thereby protecting the patient's autonomous urination function and eliminating the need for a urinary catheter; The second is the precision of thoracoscopic minimally invasive surgery. Based on thorough hemostasis and fine dissection, many patients no longer need to place thoracic drainage tubes. All of this is built on the premise of safety, while minimizing the trauma and pain of patients to the greatest extent possible. ”Liu Zhidong emphasized that Wuguan is not for the sake of not using it, but the result of the joint progress of surgery and anesthesia technology. At the same time, unregulated surgery has raised higher requirements for both surgeons and anesthesiologists. The director of the thoracic surgery department of the hospital, Han Yi, admitted that "performing surgery while maintaining partial ventilation in the lungs does increase the difficulty of the operation. Our operating space is smaller than before, and we need to complete fine operations such as anatomical separation and vascular treatment in a limited space. This requires surgeons to be more skilled and familiar with anatomical structures." "The difficulty of anesthesia management also significantly increases in ductless surgery. ”The deputy director of the anesthesia department of the hospital, Liu Wei, said that in the non intubation state, monitoring of vital signs during surgery, management of bilateral lung ventilation, and coping with cough reflex all require anesthesiologists to have richer experience and sharper judgment. This is actually a 'anesthesia driven' technological innovation. Extending from thoracic surgery to more fields, promoting innovation in the entire surgical process, under the promotion of the National Respiratory Medicine Center, currently, tubeless technology not only covers various thoracic surgeries such as lung mediastinal tumor resection, lung segment resection, and lobectomy, but also achieves interdisciplinary extension applications in urology, cardiac surgery, transplantation, orthopedics, obstetrics and gynecology, cardiology, and other fields. Our hospital mainly focuses on lung surgery, especially in the treatment of small pulmonary nodules where the effect is particularly significant. ”Han Yi said that although there are obvious advantages in unmanned technology, it is not suitable for all patients. Hospitals have strict screening criteria for patients who are eligible for unregulated technology. For some complex bronchial and pulmonary artery reconstruction surgeries, conventional procedures are still used to ensure patient safety. Liu Wei stated that the anesthesiology department will also conduct a comprehensive evaluation of patients, excluding high-risk factors such as severe cardiovascular disease, severe obesity, and airway obstruction, to ensure that the patient's cardiovascular function can tolerate spontaneous breathing during surgery. The application of non-invasive minimally invasive technology not only reduces the physiological trauma of patients, but also greatly improves the surgical experience and postoperative quality of life. The director of the thoracic surgery department of the hospital, Ruan Junzhong, said, "Rapid recovery is the most prominent advantage of unmanaged technology. Patients no longer need long-term recovery observation after surgery, and most patients can wake up within two to three hours after the surgery, and even walk back to the ward on their own. Traditional surgery requires a longer stay in the recovery room. Unmanned technology truly benefits patients: shortened hospitalization time, reduced medical costs, and improved medical experience, which is our fundamental goal." The development of unmanaged minimally invasive technology has also promoted innovation in nursing work. Zhao Jing, the head nurse of the anesthesia department at the hospital, stated that tubeless surgery significantly reduces the workload of preoperative catheterization, intraoperative catheter management, and postoperative drainage care, and reduces the risks of catheter slippage and infection. But at the same time, higher requirements are also put forward for nurses' emergency response capabilities. We have developed a comprehensive emergency plan, including the preparation of rescue equipment, drugs, tracheal intubation equipment, and how to cooperate with anesthesiologists. All processes have been pre rehearsed to ensure immediate response in case of the need to switch from laryngeal mask to tracheal intubation. ”Zhao Jing said that although there is a higher demand for emergency response capabilities, the benefits brought to patients are tangible. The nursing team will also continue to optimize the service process, providing patients with better and more efficient perioperative nursing services, and helping to deepen the practice of the concept of rapid recovery surgery. (New Society)