Comparative analysis of safety and efficacy of non-intubation in lung wedge resection using thoracoscopy: a...

Whether non-intubated thoracoscopic surgery is superior to traditional thoracoscopic surgery is still controversial, and no studies have clearly shown that non-intubated lung wedge resection is superior to or inferior to traditional lung wedge resection. The aim of this study was to investigate the safety and efficacy of lung wedge resection under non-intubation (non-invasive ventilation).

A comprehensive search of the online databases was conducted as of February 2026. The outcomes related to perioperative safety and postoperative effectiveness of the included studies were comprehensively analyzed, and a single-group meta-analysis was performed.

A total of 12 studies involving 1,167 patients [566 non-intubated group (NIG) vs. 601 intubated group (IG)] were included for analysis in our study. Operation time [52.18 vs. 61.78 min; weighted mean difference (WMD) -10.01, P=0.045], anesthesia duration (58.43 vs. 93.47 min; WMD -26.72, P=0.03), intraoperative blood loss (12.98 vs. 23.06 mL; WMD -12.42, P=0.044), emergence time [22 vs. 35.27 min; standardized mean difference (SMD) -1.00, P<0.001] were significantly less in the IG. Additionally, the postoperative hospital stay for the NIG (4.77 vs. 6.02 days; WMD =-1.24, P=0.001), postoperative visual analog scale (VAS) pain score (1.88 vs. 2.62; WMD =-0.75, P=0.06), and total hospitalization cost (€4,028 vs. 4,773; WMD =-996.60, P<0.001) were also significantly lower than those of the IG. However, postoperative chest drainage (205.6 vs. 498.3 mL; WMD =-284.76, P=0.60), chest drainage time (2.96 vs. 4.13 days; WMD =-1.18, P=0.09), and postoperative dyspnea score (1.51 vs. 1.55; WMD =-0.07, P=0.60) were not significantly different between the groups. Furthermore, lower rate of adverse effects [8.7% vs. 10.1%; odds ratio (OR) =0.79, P=0.42] and the postoperative readmission rates (3.49% vs. 5.24%; OR =0.74, P=0.51) showed no statistical differences between the groups.

Observational data suggest that non-intubation techniques are feasible and correlate with reduced surgery durations, shorter anesthesia times, decreased intraoperative blood loss, and abbreviated postoperative hospital stays. However, for spontaneous pneumothorax surgery and lung volume reduction surgery (LVRS), the advantages of non-intubation techniques are not obvious. Nevertheless, significant heterogeneity and limitations in the research preclude definitive recommendations. Due to the study limitations, additional high-quality studies are needed to confirm the safety and feasible of non-intubated LVRS and spontaneous pneumothorax surgery.