Feasibility of non-intubated uniportal video-assisted thoracic surgery for spontaneous pneumothorax: a mini-review

Non-intubated uniportal video-assisted thoracic surgery (VATS) has become a treatment of choice for thoracic diseases in some institutions to reduce postoperative pain and avoid adverse events due to general anesthesia and endotracheal intubation. However, the outcomes of non-intubated uniportal VATS for spontaneous pneumothorax remain unclear. In September 2022, a search was performed in the PubMed and Google Scholar databases for clinical studies written in English comparing the outcomes of non-intubated uniportal VATS and those of intubated uniportal VATS or other management methods for spontaneous pneumothorax. Two randomized controlled studies and one retrospective cohort study evaluated outcomes of non-intubated uniportal VATS for primary spontaneous pneumothorax in comparison to those of intubated uniportal VATS. In these studies, non-intubated uniportal VATS significantly shortened the anesthesia time or postoperative recovery time. The incidence of postoperative complications was not significantly different between the two procedures. Non-intubated uniportal VATS was associated with significantly less postoperative pain than intubated uniportal VATS in the two studies, whereas there was no significant difference between the two groups in the other study. No study has compared the outcomes of non-intubated uniportal VATS with those of other surgical procedures or non-surgical management of secondary spontaneous pneumothorax. The short-term outcomes of non-intubated uniportal VATS for primary spontaneous pneumothorax appear to be more favorable than those of intubated uniportal VATS based on the limited amount of available literature. Further studies are required to determine the role of non-intubated uniportal VATS in the treatment of primary and secondary spontaneous pneumothorax, including the long-term efficacy of this procedure.