Nonintubated video-assisted thoracic surgery: myth or reality?

This review discusses nonintubated video-assisted thoracic surgery (NIVATS) by presenting its physiological, technical aspects and recent clinical data from the literature.

In the last two decades, NIVATS has gained traction as an alternative to traditional intubated thoracic surgery, offering potential benefits in terms of reduced complications, faster recovery times, and improved patient satisfaction. Several approaches to this technique have been described in the literature, mainly divided into the awake patient technique (awake-NIVATS) and the asleep patient technique (asleep-NIVATS). The availability of various sedatives, numerous devices to ensure good oxygenation, and the countless loco-regional techniques available today for pain control in the thoracic region offer the possibility to develop many anesthesia protocols in this context. Numerous studies have already shown that NIVATS is feasible and safe with proper patient selection and adequate collaboration of the surgical team. Some studies have also shown that NIVATS may improve patient outcomes, but the evidence is still limited.

Literature has demonstrated the feasibility of NIVATS and suggest that it can improve patient outcomes. High-quality international randomized multicenter studies comparing NIVATS and intubated video-assisted thoracic surgery are necessary for a strong comprehension to clarify whether it can be a technique that can guarantee safety and improve the perioperative course of patients.