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Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
Published on: May 26, 2023
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Is Less More? A Meta-Analysis of Non-Intubated Versus Intubated VATS for Anatomic Resections in Non-Small Cell Lung
Dimitrios E Magouliotis1, Anna P Karamolegkou2, Prokopis-Andreas Zotos3
1Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA.
Journal of Clinical Medicine
|October 16, 2025
Summary
Non-intubated video-assisted thoracoscopic surgery (NIVATS) is a safe and effective alternative to intubated VATS (IVATS) for lung cancer surgery, offering improved perioperative outcomes. This approach enhances recovery without compromising oncologic standards for selected patients.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Minimally Invasive Procedures
Background:
- Non-intubated video-assisted thoracoscopic surgery (NIVATS) offers a less invasive approach for lung cancer resection compared to conventional intubated VATS (IVATS).
- Concerns persist regarding the safety, efficacy, and oncologic adequacy of NIVATS for non-small cell lung cancer (NSCLC) lobectomy.
Purpose of the Study:
- To conduct a meta-analysis comparing perioperative and short-term outcomes between NIVATS and IVATS for NSCLC lobectomy.
- To evaluate the safety, efficacy, and oncologic outcomes of NIVATS versus IVATS.
Main Methods:
- Systematic review and meta-analysis of studies comparing NIVATS and IVATS for anatomical lung resections in NSCLC.
- Searched PubMed, Scopus, and Cochrane CENTRAL databases; included seven studies (851 patients); assessed risk of bias using ROBINS-I and Newcastle-Ottawa Scale.
Main Results:
- NIVATS demonstrated significantly lower postoperative complications, shorter operative and anesthetic times, and reduced intraoperative blood loss compared to IVATS.
- No significant differences were observed in lymph node yield or conversion to thoracotomy rates.
- No 30-day mortality was reported in either group; study quality was moderate with no evident publication bias.
Conclusions:
- NIVATS is a safe and effective alternative to IVATS for selected NSCLC lobectomy patients, improving perioperative outcomes.
- NIVATS maintains surgical and oncologic standards, suggesting its viability for lung cancer treatment.
- Further prospective trials are recommended to validate these findings and assess long-term survival benefits.
