Non-intubated video-assisted thoracoscopy : a narrative review

Abstract

Non-intubated video-assisted thoracoscopic surgery (NIVATS) is an emerging technique in thoracic surgery that avoids the use of general anaesthesia and mechanical ventilation. The evolution from traditional VATS to NIVATS has shown significant potential in reducing postoperative complications, shortening hospital stays, and improving patient satisfaction. By allowing spontaneous breathing, NIVATS minimizes the invasiveness of thoracic procedures and reduces the risks associated with tracheal intubation and general anaesthesia. A comprehensive literature search was conducted across multiple databases, including the Cochrane Library, Embase, Medline (Ovid), PubMed, and Scopus, focusing on studies published between 2013 and 2023. Keywords included terms related to NIVATS, spontaneous breathing, and one-lung ventilation. The search yielded 56 relevant studies selected for inclusion in our review.

This narrative review explores the physiological aspects and clinical implications induced by the respiratory management in thoracoscopic surgery. It also examines equipment and techniques for lung isolation, emphasizing the importance of optimizing perioperative management.

In conclusion, both VATS and NIVATS offer significant advantages over traditional open thoracotomy. NIVATS, in particular, shows promise in enhancing patient outcomes through reduced complications and faster recovery. We present our current protocol for NIVATS at the University Hospitals in Leuven, although further studies areneeded to confirm these benefits and refine protocols for broader clinical adoption.