Research advances of tubeless thoracic surgery for pulmonary nodules: current status and future challenges

This narrative review aims to summarize the current research progress on Tubeless thoracic surgery for pulmonary nodules, analyze its physiological basis and clinical applications, and outline future directions.

A literature search was performed in PubMed and Web of Science from database inception to December 2025 using the following Boolean search string: ("Tubeless" OR "non-intubated" OR "spontaneous ventilation") AND ("VATS" OR "video-assisted thoracoscopic surgery") AND ("pulmonary nodules" OR "lung nodules" OR "GGN"). A total of 1,902 records were identified. After title and abstract screening independently by two authors, 59 articles were finally included. Eligible studies included randomized controlled trials, prospective and retrospective cohort studies, case series (n ≥ 10), and expert consensus statements. Only English-language articles were included, as the review is intended for an international readership. Given the heterogeneous nature of the available evidence, this review is presented as a narrative synthesis with no formal quality assessment or meta-analysis.

Data from heterogeneous studies suggest reductions in laryngeal edema, postoperative nausea and vomiting, pain, and hospital stay, although direct comparisons should be interpreted with caution. However, risks include intraoperative hypercapnia and the potential need for conversion to intubation. Long-term oncological safety remains unconfirmed.

In carefully selected patients and experienced centers, available evidence suggests that Tubeless technology may optimize perioperative management and enhance recovery after pulmonary nodule resection. Future efforts should focus on integrating electromagnetic navigation bronchoscopy, artificial intelligence for risk prediction, and day-surgery pathways to maximize clinical and economic benefits.