| Criteria for a conversion to thoracotomy or general anesthesia |
| Respiratory acidosis with pH <7.1, with taquipnea (higher than 30 rpm) |
| Hypoxemia (pO2 <60 mmHg) with no improvement despite high flow oxygenation nor non invasive-ventilation |
| Continuous cough with no improvement despite aerosolized lidocaine nor vagal blockade |
| Anxiety attack with no improvement with sedation |
| Moderate to major bleeding, uncontrollable with the single incision/awake procedure, which requires more important maneuvers (pulmonary artery clamp, primary suture, reconstruction) |
| Non adequate lung collapse which make lung mobilization and resection difficult |
| Adhesions in more than 50% of the lung surface which lengthens the procedure or makes the procedure difficult |
| Impossibility of nodule palpation through the single-incision or the awake fashion (small nodules, central location, excessive cough reflex without improvement with vagal blockade) |
| Pulmonary lesions requiring major lung resection (lobectomy, pneumonectomy) through the single-incision/awake procedure (relative criteria) |
| Patient voluntary desire of conversion |
| Conversion to general anesthesia/thoracotomy |
| Introduce thoracic drainage through the incision, connect it to water seal system and close the wound with a sterile transparent dressing around the drainage, to let the lung reexpand again and improve oxygen saturation or dyspnea |
| General anesthesia and orotracheal lateral decubitus intubation |
| Perform the thoracotomy or the additional ports and proceed |
