Comparative analysis of safety and outcomes of Non-intubated versus intubated uniportal video-assisted thoracic surgery using propensity score matching: a single-center experience expanding indications beyond traditional restrictions - Report - MDSpire
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Comparative analysis of safety and outcomes of Non-intubated versus intubated uniportal video-assisted thoracic surgery using propensity score matching: a single-center experience expanding indications beyond traditional restrictions
Safety and Outcomes of Non-intubated vs. Intubated Uniportal VATS: Propensity Matched Study
Overview
This retrospective propensity score matched analysis compared non-intubated (NI-UVATS) and intubated uniportal video-assisted thoracic surgery (I-UVATS) in 196 patients. NI-UVATS demonstrated comparable safety and feasibility for low-to-medium complexity thoracic procedures, with similar rates of serious complications and mortality despite longer operative times.
Background
Non-intubated uniportal video-assisted thoracic surgery (NI-UVATS) has emerged as an alternative to conventional intubated approaches, initially reserved for high-risk patients to reduce ventilator-associated complications. Evidence from randomized trials and meta-analyses supports NI-UVATS for shorter hospital stays and fewer postoperative complications. However, its applicability to complex anatomical resections remains limited due to technical challenges such as incomplete lung isolation and the need for experienced anesthetic management.
Data Highlights
Outcome
I-UVATS (n=98)
NI-UVATS (n=98)
p-value
Serious complications (overall)
14.3%
11.2%
0.522
Serious complications (low complexity)
10.8%
7.4%
0.545
Serious complications (medium complexity)
16.0%
16.7%
0.959
Operative time (median minutes)
37
52
0.042
30-day mortality
12.2%
7.1%
0.240
1-year surgery-related mortality
10.2%
15.3%
0.291
Anatomical resections
36.7%
5.1%
<0.001
Key Findings
NI-UVATS is safe and feasible for low-to-medium complexity thoracic procedures with comparable serious complication rates to I-UVATS.
Operative time was significantly longer in the NI-UVATS group (median 52 vs. 37 minutes).
There was a marked procedural imbalance: anatomical resections were predominantly performed in the I-UVATS group (36.7%) versus NI-UVATS (5.1%).
30-day and 1-year surgery-related mortality rates did not differ significantly between groups.
NI-UVATS was primarily utilized for diagnostic and pleural procedures, reflecting current clinical practice.
Clinical Implications
NI-UVATS can be considered a safe alternative to intubated approaches for selected patients undergoing low-to-medium complexity thoracic surgeries, potentially reducing ventilator-associated risks. However, anatomical resections remain largely performed under intubation due to technical challenges. Careful patient selection and experienced anesthetic teams are essential for successful NI-UVATS implementation.
Conclusion
This study supports the safety and feasibility of NI-UVATS for less complex thoracic procedures in real-world practice, while highlighting the need for further randomized trials to define its role in complex anatomical resections.
References
Wolfson Medical Center Study 2017-2025 -- Evaluation of Safety and Outcomes in Non-intubated versus Intubated Uniportal VATS
