Supine awake subxiphoid lung resection in a severe obese patient with idiopathic pulmonary fibrosis

Surgical biopsy of idiopathic pulmonary fibrosis (IPF) is still associated with not negligible mortality, especially for acute exacerbation. Nowadays, minimally invasive thoracoscopic surgery under general anesthesia is the gold standard procedure. We report a case of a very high-risk patient because of severe obesity and acute respiratory failure who underwent surgical biopsy. A multidisciplinary approach is mandatory to achieve good results in such fragile patients. Awake thoracoscopic subxiphoid approach could be very effective to reduce morbidity and mortality in IPF patients who needs surgical biopsy. The supine position could be useful in obese patients or in patients with difficult airway management.