Background: Subxiphoid approach for mediastinal tumor resection was reported to provide a better view and less postoperative pain. Non-intubated video-assisted thoracic surgery (NI-VATS) without muscle relaxant would decrease the possibility of postoperative airway collapse for anterior mediastinal mass operation. Herein, we sought to describe the use of NI-VATS through subxiphoid approach for anterior mediastinal tumor resection. Methods: In this retrospective cohort study, patients that underwent subxiphoid VATS resection for anterior mediastinal tumor between December 2015 and September 2019 were divided into two groups: NI-VATS and intubated VATS (I-VATS). Intraoperative and postoperative variables were compared. Results: A total of 40 patients were included. Among them, 21 patients received NI-VATS (52.5%) and 19 were treated with I-VATS (47.5%). In total, intraoperative (4/21 vs. 2/19; P=0.446) and postoperative complications (5/21 vs. 7/19; P=0.369) were similar between NI-VATS and I-VATS group. The anesthesia time (231.76 vs. 244.71 min; P=0.218), the operation time (152.35 vs. 143.64 min; P=0.980), chest tube duration (1.81 vs. 1.84 days; P=0.08), the total volume (351.95 vs. 348.00 mL; P=0.223), post-operative pain scores (2.79 vs. 2.93, P=0.413), and the length of stay (9.47 vs. 10.57 days; P=0.970) were all comparable between two groups.Conclusions: NI-VATS for mediastinal tumor resection via subxiphoid approach is a safe and technically feasible option in selected patients, which leads to comparable perioperative clinical outcomes when compared with I-VATS via the subxiphoid approach. This technique could be used as an alteration when intubation is not available.

Objective Subxiphoid approach for mediastinal tumor resection was reported to provide a better view and less postoperative pain. Non-intubated video-assisted thoracic surgery (NI-VATS) without muscle relaxant would decrease the possibility of postoperative airway collapse for anterior mediastinal mass operation. Herein, we sought to describe the use of NI-VATS through subxiphoid approach for anterior mediastinal tumor resection. Methods Patients that underwent subxiphoid VATS resection for anterior mediastinal tumor between December 2015 and September 2019 were retrospectively included for analysis. Patients were divided into two groups according to airway management: NI-VATS and intubated VATS (I-VATS). Intraoperative and postoperative variables were compared. Results A total of 40 patients were included. Among them, 21 patients received NI-VATS (52.5%) and 19 were treated with I-VATS (47.5%). In total, intraoperative (4/21 vs. 2/19; p = 0.446) and postoperative complications (5/21 vs. 7/19; p = 0.369) were similar between NI-VATS and I-VATS group. The anesthesia time (231.76 vs 244.71 min; p = 0.218), the operation time (152.35 vs 143.64 min; p = 0.980) and the length of stay (9.47 vs 10.57 day; p = 0.970) were similar between the two groups. Chest tube duration was shorter in NI-VATS groups (1.81 vs 1.84 day; p = 0.008), however, the total volume (351.95 vs 348.00 ml; p = 0.223) was similar. The post-operative pain scores (2.79 vs 2.93, P = 0.413) were comparable between two groups. Conclusions NI-VATS for mediastinal tumor resection via subxiphoid approach is a safe and technically feasible option. This technique leads to comparable perioperative clinical outcomes when compared with I-VATS via subxiphoid approach.