Contralateral pneumothorax: the hidden culprit in failed oxygenation during non-intubated videoassisted thoracoscopic surgery

The occurrence of contralateral pneumothorax during non-intubated video-assisted thoracoscopic surgery (NiVATS) is rare and difficult to diagnose intraoperatively due to its non-specific clinical presentations. Temporary desaturation is not uncommon in NiVATS. This report highlights a case where maintaining oxygenation proved challenging despite various remedial interventions, ranging from use of high-flow oxygen delivery to manual jet ventilation via Cook airway exchange catheter during right NiVATS for distal tracheal mass resection and reconstruction. Intermittent cross-field ventilation was employed during tumour removal and tracheal anastomosis to maintain oxygenation. Postoperative chest X-ray revealed the reason for oxygenation failure: pneumothorax on the left side. The left-side chest tube was not inserted because the patient remained asymptomatic post-extubation. The patient was discharged well on postoperative day 8. Repeated bronchoscopy at 1-month post-surgery revealed intact anastomosis. Prompt diagnosis of pneumothorax in high-risk surgeries and contingency airway plans are imperative in managing patients undergoing NiVATS to prevent airway mishaps.