Non-intubated vs. intubated video-assisted thoracoscopic surgery for the treatment of thoracic diseases: a systematic review and meta-analysis of propensity score-matched cohorts.

Background: Video-assisted thoracic surgery (VATS) is commonly conducted under general anesthesia with tracheal intubation, which can lead to intubation-related complications. Consequently, non-intubated video-assisted thoracoscopic surgery (NIVATS) has gained increasing attention. However, debates persist regarding its safety and efficacy. This study aims to compare the safety and efficacy of NIVATS vs. intubated VATS (IVATS) in thoracic surgery. Methods: Relevant literature published up to October 2024 was collected from the Cochrane, PubMed, and Embase databases based on predefined inclusion criteria. Two reviewers independently screened these studies and extracted the pertinent data. After assessing the quality of the included studies, a meta-analysis was performed using Review Manager 5.3. Fixed-effects or random-effects models were utilized to synthesize the combined data. Results: Compared with IVATS, NIVATS demonstrated shorter operative time [weighted mean difference (WMD) = -23.33 min; 95% confidence interval (CI), -33.62 to -13.04; Conclusion: Although there were no significant differences between the two anesthesia methods concerning postoperative length of hospital stay, lymph node dissection, or intraoperative bleeding, NIVATS significantly reduced operative time, anesthesia time, length of hospital stay, and chest tube drainage duration. For highly selected patients, NIVATS may offer additional advantages. However, the increased postoperative complication rate associated with NIVATS compared with IVATS warrants further large, well-designed randomized trials.