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Meta-Analysis
. 2025 May 29;25(1):272.
doi: 10.1186/s12871-025-03154-3.

Comparison of non-intubated and intubated video-assisted thoracoscopic surgery for perioperative complications-a systematic review and meta-analysis

Diaofeng Zhang #  1 , Jie Wu #  1 , Yihan Yang  1 , Ruifang Pu  1 , Zixiao Liu  1 , Yun Li  1 , Wei Deng  2 , Jiale Wang  3 , Bo Hou  4 , Zengcai Ge  1 , Jiao Gao  1 , Jiangang Li  5 , Liming Cheng  6
Affiliations
Meta-Analysis

Comparison of non-intubated and intubated video-assisted thoracoscopic surgery for perioperative complications-a systematic review and meta-analysis

Diaofeng Zhang et al. BMC Anesthesiol. .

Abstract

Background: Non-intubated video-assisted thoracic surgery (NIVATS) avoids lung injury and intubation-related complications from mechanical ventilation, but the intraoperative safety and postoperative recovery quality of NIVATS remain controversial. Consequently, we systematically assessed the viability and safety of non-intubated video-assisted thoracic surgery (NIVATS) in comparison to intubated video-assisted thoracic surgery (IVATS). These findings provide evidence for optimizing anesthetic and surgical decision-making.

Methods: PubMed, Web of Science, Embase, Cochrane Library, OVID, and Google Scholar were queried from their establishment until October 2024. We included eligible studies that compared non-intubated anesthesia with intubated anesthesia for video-assisted thoracoscopic surgery for thoracic conditions. Following the evaluation of bias risk in these randomized controlled trials (RCTs), a meta-analysis was conducted using Review Manager (Manager 5.4).

Results: Nineteen randomized controlled trials were incorporated into the study. NIVATS demonstrated a reduced length of hospital stay, feeding time, and chest-tube dwell time compared to intubated methods. IVATS groups, hypoxemia exhibited a reduced incidence, but perioperative cough and perioperative arrhythmias revealed no statistically significant differences between IVATS and NIVATS groups. The NIVATS groups exhibited a significantly reduced risk compared to the IVATS groups for postoperative pulmonary complications (PPCs), postoperative nausea and vomiting (PONV), and sore throat.

Conclusions: NIVATS avoid complications associated with intubation and are able to accelerate patient recovery to a certain extent. Although NIVATS carries intraoperative safety risks, careful patient selection can mitigate these risks.

Keywords: Length of hospital stay; Meta-analysis; Non-intubated anesthesia; PPCs; Thoracic surgery; VATS.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The project was exempted from an ethical opinion by the Ethics Committee of Qujing First People's Hospital: Kunming Medical University Affiliated Qujing Hospital since it is a systematic review of the literature. Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Risk of bias analysis for the RCTs. A Risk of bias summary reviewing the authors’ judgments regarding each risk of bias item for each included study. B Risk of bias graph reviewing the authors’ judgments regarding each risk of bias item presented as percentages across all included studies. RCTs, randomized controlled trials
Fig. 3
Fig. 3
Forest plot of the length of hospital stay
Fig. 4
Fig. 4
Forest plot of feeding time
Fig. 5
Fig. 5
Forest plot of VAS
Fig. 6
Fig. 6
Forest plot of surgery duration
Fig. 7
Fig. 7
Forest plot of PPCs
See this image and copyright information in PMC

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