A comparison of non-intubated video-assisted thoracic surgery with spontaneous ventilation and intubated video-assisted thoracic surgery: a meta-analysis based on 14 randomized controlled trials

Zhang, Xi-Xuan; Song, Chun-Tao; Gao, Zhen; Zhou, Bin; Wang, Haibo; Gong, Qiang; Li, Ben; Guo, Qiang; Li, Hefei

doi:10.21037/jtd-20-3039

Cited by 24 publications

(17 citation statements)

References 47 publications

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“…Wen et al conducted a meta-analysis of 27 studies on SV-VATS and concluded that the advantages of SV-VATS in reducing postoperative complications and accelerating postoperative recovery compared to traditional MV-VATS (11). A meta-analysis of 14 RCTs of two VATS modes reported that SV-VATS reduced postoperative hospital stay and patients' subjective discomfort after surgery (12). A meta-analysis involving more than 1,600 patients reached similar conclusions (13).…”

Section: Discussionmentioning

confidence: 97%

SV-VATS exhibits dual intraoperative and postoperative advantages

Xu¹,

Li²,

Ning³

et al. 2021

Ann Transl Med

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Background: The merits of spontaneous ventilation video-assisted thoracic surgery (SV-VATS) are still controversial. Our team retrospectively evaluated the intraoperative and postoperative advantages of this surgical approach, comparing with mechanical ventilation video-assisted thoracic surgery (MV-VATS).Methods: We did a single center retrospective study at the First Affiliated Hospital of Yunnan Province. 244 patients were eventually assigned to the SV-group and MV-group, and their intraoperative indicators and thoracic surgery postoperative data were included in the comparison. Results:The SV-group exhibited markedly less intraoperative bleeding and postoperative thoracic drainage, and the bleeding volume was correlated with the volume and duration of drainage. Further analysis showed that, patients undergoing SV-VATS had less activation of white blood cells and neutrophils after surgery, but they also had lower serum albumin concentrations. Risks of short-term postoperative complications, including inflammatory reactions, malignant arrhythmias, constipation, and moderate or more pleural effusions, were also significantly reduced in the SV-group. Additionally, hospitalization cost was lower in the SV-group than that in the MV-group.Conclusions: SV-VATS is suitable for various types of thoracic surgery, and effectively reduce intraoperative bleeding and postoperative thoracic drainage. With less postoperative inflammatory response, it reduces the risk of short-term postoperative complications. It is also able to help to reduce the financial burden of patients.

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Section: Discussionmentioning

confidence: 97%

SV-VATS exhibits dual intraoperative and postoperative advantages

Xu¹,

Li²,

Ning³

et al. 2021

Ann Transl Med

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“…A meta-analysis by Zhang et al based on 14 RCTs, also reported technical outcomes, such as surgical field satisfaction (SFS), and anaesthesia satisfaction scores (ASC). SFS was measured on a scale from 1-4 (1: best vision and lung collapse; and 4: worst exposure to the surgical field and the need to convert to intubation), and did not confirm significant difference in NI-VATS vs. I-VATS, however ASC proved to be significantly higher in cases of NI-VATS (35). With the spread of NI-VATS, the importance of careful patient selection also needs to be addressed.…”

Section: Anaesthesia For Ni-vats and I-vatsmentioning

confidence: 97%

“…Results have also shown that overall complication rate was lower in NI-VATS [odds ratio (OR) 0.41; 95% CI: 0.25 to 0.67; P=0.0004], with decreased incidence of air-leaks (OR 0.45; 95% CI: 0.24 to 0.87; P=0.02) and postoperative hoarseness (OR 0.06; 95% CI: 0.02 to 0.21; P<0.00001) (35).…”

Section: Anaesthesia For Ni-vats and I-vatsmentioning

confidence: 99%

Do we even need to relax? Evolution of non-intubated video assisted thoracic surgery thymectomy for myasthenia gravis—a narrative review

Rieth¹,

Lázár²,

Kovács³

et al. 2022

AME Surg J

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Objective: Traditional approaches to thymectomy for myasthenia gravis (MG) formerly included open sternotomy and later video-assisted-(VATS) and robot-assisted thoracic surgery (RATS) through traditional double-lumen intubation anaesthesia. The aim of the review was to describe current role of non-intubated (NI) minimally invasive techniques in thoracic surgery with emphasis on NI-VATS thymectomy and point out advantages and disadvantages of the method from both the surgical-and anaesthesiological point of view.Background: With the introduction of non-intubated thoracic surgery (NITS) pioneer surgeons and anaesthesiologists have managed to carry out various thoracic surgery procedures from major lung resections to thymectomy without having to deal with the disadvantages of traditional intratracheal tube placement and reduce adverse effects of intubation, such as tracheal injury, lung infections, or hoarseness. Without the need of muscle relaxants, faster overall recovery can be achieved, granting improved postoperative patient outcomes, especially in cases of MG.Methods: Evolution of the NI technique and important results are presented through literature data and references. Only published manuscripts written in English language were considered including case reports, retrospective-, and prospective cohorts, meta-analysis, systematic reviews and randomized controlled trials.Conclusions: Although NI-VATS thymectomy remains a promising novel approach with numerous apparent benefits, further data evaluation and larger scale of patient outcome analysis is needed to determine exact indications and feasibility of the technique.

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“…Relative contraindications include hemodynamic instability, obesity with body mass index (BMI) greater than 30, high airway secretions, coagulopathy, and extensive adhesions from prior surgery leading to surgical difficulty (33). Patients can be maintained as spontaneously breathing from the beginning or return to spontaneously breathing before the airway is open (35)(36)(37).…”

Section: Nonintubated Spontaneous Breathingmentioning

confidence: 99%

Airway management and anesthesia for airway surgery: a narrative review

Li¹,

Chitilian²,

Alfille³

et al. 2021

Transl Lung Cancer Res

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Objective: To discuss and summarize the literature for airway and anesthetic management tools the anesthesiologist can use for airway surgery to both successfully manage the patient's physiological needs and provide the surgeon the optimal surgical conditions with which to perform the surgery safely. Background:The airway and anesthetic management of patients presenting for thoracic surgery poses the anesthesiologist with a unique set of challenges, but also a unique set of opportunities to artfully utilize and adapt a variety of management options that has developed over several decades of innovation. Sixty years ago, airway surgery was initially performed with the patient spontaneously breathing and providing anesthesia with halogenated agents and airway topicalization. As medicine entered the latter half of the twentieth century with its development of new airway devices and modern anesthetic agents, most airway surgeries could be safely performed under general anesthesia with secured airways. Today, with continued technological advancements in surgical techniques and an expanding population of challenging patients, the application of nonintubated anesthetic techniques and extracorporeal support is on the rise. Methods:We conduct a narrative review of the literature on the history of airway and anesthetic management for thoracic surgery, the current management methods and evidence for each modality, and discuss future directions for the field.Conclusions: While the airway and anesthetic management for airway surgery is challenging, the anesthesiologist has a variety of options including cross-field ventilation, jet ventilation, nonintubated techniques, and extracorporeal support to safely care for the patient. Whichever methods are chosen for the patient and surgery, thoracic surgery remains uniquely positioned in its need for close sharing and collaboration of all airway and anesthetic management decisions between the anesthesiologist and the surgeon.

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A comparison of non-intubated video-assisted thoracic surgery with spontaneous ventilation and intubated video-assisted thoracic surgery: a meta-analysis based on 14 randomized controlled trials

Cited by 24 publications

References 47 publications

SV-VATS exhibits dual intraoperative and postoperative advantages

SV-VATS exhibits dual intraoperative and postoperative advantages

Do we even need to relax? Evolution of non-intubated video assisted thoracic surgery thymectomy for myasthenia gravis—a narrative review

Airway management and anesthesia for airway surgery: a narrative review

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