Impact of spontaneous ventilation with intubation on perioperative results in uniportal VATS lobectomy compared to general anaesthesia using a double-lumen tube

Background: Minimally invasive thoracic surgery is the most frequently used approach for lung resection to minimize surgical stress on the patient. To further reduce invasiveness, the non-intubated spontaneous ventilation method is applied on the anesthesia side. However, due to the unsafe airway associated with this procedure, this method is not widely adopted. This study analyzes the surgical results of our method, which involves spontaneous ventilation with double lumen tube intubation and uniportal video-assisted thoracic surgery (VATS) lung lobectomies. Methods: Between 2015 and 2023, 302 patients underwent uniportal VATS lobectomy in two different periods, depending on the type of anesthesia. Between 2015 and 2019, traditional relaxation, double lumen tube intubation, and general anesthesia (GA) with mechanical one-lung ventilation were used for lobectomies in 210 patients (93 males, 117 females, mean age 64.3 years) (GA-VATS group). Between 2021 and 2023, 92 cases (44 males, 48 females, mean age 66.3 years) underwent lobectomy with spontaneous ventilation after a short relaxation period, double lumen intubation, and vagus nerve blockade (SVI-VATS group). Perioperative data from 66 patients in each group were analyzed after 1:1 sample propensity score matching (caliper 0.1). Results: Respecting all patients, in the GA-VATS and SVI-VATS groups, the mortality and morbidity rates were 1 (0.47%) and 0 (0%), and 52 (24.7%) (P=0.050) and 19 (20.6%) (P=0.32), respectively. The rate of grade IIIB complications was 13 (6.1%) in the GA-VATS group and 0 (0%) in the SVI-VATS group (P=0.01). The length of surgery was 91.1 vs. 86.4 min (P=0.10), duration of chest drainage was 4.64 +/- 4.58 vs. 3.39 +/- 3.39 days (P=0.02), the rate of permanent air leak was 43 (20.4%) vs. 8 (8.7%) (P=0.001), reoperation rate was 11 (5.2%) vs. 0 (0%) (P=0.02), and the number of removed mediastinal lymph nodes was 12.7 vs. 12.7 (P=0.97) in the GA-VATS and SVI-VATS groups, respectively. After propensity score-matched analysis, there were no cases of mortality in either group. Morbidity rates were 19 (28.8%) and 15 (22.7%) (P=0.55), length of surgery was 99 vs. 86.7 min (P=0.003), duration of chest drainage was 5.1 vs. 3.8 days (P=0.02), the rate of permanent air leak was 15 (22.7%) vs. 8 (12.1%) (P=0.10), and the reoperation rate was 5 (7.57%) vs. 0 (0%) (P=0.058) in the GA-VATS and SVI-VATS groups, respectively.Conclusions: SVI-VATS lobectomy resulted in fewer complications, particularly those requiring correction under anesthesia (IIIb) and a shorter postoperative period than GA-VATS. The number of removed mediastinal lymph nodes was similar between the groups.