Abstract
It remains unclear whether the feasibility and safety of non-intubated VATS under LA is comparable or advantageous compared with conventionally intubated VATS under GA in different thoracic diseases. Consequently, a meta-analysis was conducted with the aim of assessing whether non-intubated VATS offered better perioperative outcomes over intubated VATS in terms of diverse thoracic diseases, including pulmonary nodules, spontaneous pneumothorax, and malignant pleural effusion. A comprehensive search of online databases was performed. Intraoperative and postoperative variables were compared between the subgroups. The odds ratio (OR) or SMD and its 95% CI was calculated using a random effects model. Heterogeneity across studies was examined by the Cochran Q chi-square test and the I2 statistic. A total of 15 eligible studies including 1964 patients were recruited. Each included study had comparable baseline characteristics and the same surgical procedures except for the regimens of anesthesia and ventilation. Non-intubated anesthesia VATS was performed on 959 patients, whereas the other 1005 patients underwent intubated VATS. In the overall analysis, patients who underwent non-intubated surgery associated with significant shorter postoperative hospital stays (SMD=-0.36, p<0.001), postoperative fasting time (SMD=-2.80, p<0.001) and anesthesia time as well as lower rates of mortality, postoperative overall, respiratory, and cardiovascular complications. Patients underwent non-intubated surgery also manifested a trend toward shorter operative time and less blood loss with no significant significance. Non-intubated VATS was confirmed as a safe and feasible alternative to intubated VATS and potentially provided a more rapid postoperative rehabilitation than intubated VATS overall and specifically in the management of pulmonary nodules, spontaneous pneumothorax, and malignant pleural effusion. Future large-scale multicenter studies are supposed to focus on prospective validation of feasibility and safety and immunological changes for non-intubated thoracoscopic approach
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