Non-Intubated (Sedation) Versus Intubated General Anesthesia for VATS Pulmonary Spontaneous Ventilation Anesthesia: A...

Area of Science:

• Thoracic Surgery
• Anesthesiology
• Oncology

Background:

• Non-intubated video-assisted thoracoscopic surgery (VATS) with sedation anesthesia (SA) is an emerging alternative to general anesthesia (GA) with tracheal intubation.
• The safety and perioperative efficacy of SA for VATS remain incompletely defined, particularly concerning oncologic quality metrics.

Purpose of the Study:

• To compare the safety and perioperative efficacy of non-intubated SA with intubated GA for VATS.
• To evaluate oncologic quality metrics in patients undergoing SA for suspected or confirmed malignancy.

Main Methods:

• Systematic literature search of PubMed, Web of Science, and CNKI through June 2025.
• Meta-analysis of five comparative studies (112 SA; 119 GA) using random-effects models.
• Primary outcomes: overall procedural time, postoperative length of stay (LOS), and perioperative complications. Secondary outcome: operative duration.

Main Results:

• Overall procedural time was significantly shorter with SA (SMD -0.39).
• Postoperative LOS was shorter with SA (SMD -1.41), though with high heterogeneity.
• Perioperative complication rates were comparable between SA and GA, with a nonsignificant trend favoring SA for operative duration.

Conclusions:

• Sedation anesthesia (SA) is a feasible alternative to intubated general anesthesia (GA) for VATS, potentially reducing procedural time and LOS without increasing complications.
• Caution is advised for U.S. practice due to oncologic standards and lower adoption rates.
• Further prospective randomized trials with standardized endpoints are necessary to confirm these findings.