[Non-Intubated Video-assisted Thoracoscopic Surgery (niVATS)]

Area of Science:

• Thoracic Surgery
• Minimally Invasive Procedures
• Respiratory Physiology

Background:

• Minimally invasive lung surgery without endotracheal intubation has seen increased adoption for minor thoracic procedures like pleurodesis and wedge resections.
• However, anatomical lung resections performed under spontaneous breathing remain technically demanding.
• Existing evidence supporting this advanced technique is often conflicting, limiting its widespread implementation.

Purpose of the Study:

• To provide a historical overview of non-intubated minimally invasive lung surgery.
• To critically evaluate the advantages and limitations of performing anatomical lung resections under spontaneous breathing.
• To offer a guideline for establishing dedicated programs for this surgical approach.

Main Methods:

• Literature review of historical developments in non-intubated thoracic surgery.
• Critical analysis of current data on the benefits and drawbacks of spontaneous breathing anatomical resections.
• Development of a proposed guideline for program implementation.

Main Results:

• The technique is established for simpler procedures but faces challenges in complex anatomical resections due to technical demands.
• Conflicting data exists regarding the efficacy and safety of spontaneous breathing anatomical lung resections.
• A structured guideline is proposed to aid in the development of specialized surgical programs.

Conclusions:

• Non-intubated minimally invasive lung surgery is feasible for minor thoracic procedures.
• Anatomical lung resections under spontaneous breathing require further investigation and specialized programs.
• Guidelines are essential for the safe and effective implementation of advanced non-intubated surgical techniques.