Non-intubated spontaneous ventilation in video-assisted thoracoscopic surgery: a meta-analysis

It remains unclear whether non-intubated video-assisted thoracoscopic surgery (VATS) is comparable or advantageous compared with conventional intubated VATS. Thus, we systematically assessed the feasibility and safety of non-intubated VATS compared with intubated VATS perioperatively for the treatment of different thoracic diseases. An extensive search of literature databases was conducted. Perioperative outcomes were compared between 2 types of operations. The time trend of the overall results was evaluated through a cumulative meta-analysis. Subgroup analyses of different thoracic diseases and study types were examined. Twenty-seven studies including 2537 patients were included in the analysis. A total of 1283 patients underwent non-intubated VATS; intubated VATS was performed on the other 1254 patients. Overall, the non-intubated VATS group had fewer postoperative overall complications [odds ratios (OR) 0.505; P<0.001]; shorter postoperative fasting times [standardized mean difference (SMD) -2.653; P<0.001]; shorter hospital stays (SMD -0.581; P<0.001); shorter operative times (SMD -0.174; P=0.041); shorter anaesthesia times (SMD -0.710; P<0.001) and a lower mortality rate (OR 0.123; P=0.020). Non-intubated VATS may be a safe and feasible alternative to intubated VATS and provide a more rapid postoperative rehabilitation time than conventional intubated VATS.