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Background and Aims Pulmonary Langerhans cell histiocytosis (PLCH) is a diffuse lung disease caused by accumulation of large numbers of CD1a+ cells in bronchiolocentric granulomas. It usually occurs in young adult smokers and may affect bronchiolar, interstitial and pulmonary vascular compartments. One-lung ventilation during video-assisted thoracoscopy (VATS) has been associated with acute lung injury which can lead to damage to the lung parenchyma. Evidence suggests that VATS performed under regional anesthesia may improve patient outcomes when compared to general anesthesia.

Results A 30-year-old male diagnosed with PLCH presented for atypical resection of the left upper and lower lobes, partial pleurectomy and talc pleurodesis via VATS. He was a former smoker and had been transferred from another institution for recurrent left pneumothorax. The procedure was performed under locoregional anesthesia and sedation. Single-shot paravertebral block was placed under ultrasound guidance at levels T2 to T8 with levobupivacaine 0.5%, 5 mL per level. Sedation was performed with ketamine and dexmedetomidine infusion. Multimodal analgesia was administered. The surgery was completed with minor blood loss and the patient was discharged after five days without complications.

Conclusions VATS under locoregional anesthesia is feasible and has been associated with faster postoperative recovery, better postoperative analgesia and shorter length of hospital stay. In patients with interstitial lung disease, lung biopsies performed via VATS also showed a reduction of postoperative morbidity, mortality, reintervention rates and unplanned ICU admissions. Therefore, VATS under locoregional anesthesia should be considered in selected patients with high risk for complications under general anesthesia.