Original Article
Non-intubated video-assisted thoracoscopic surgery vs. intubated video-assisted thoracoscopic surgery for thoracic disease: a systematic review and meta-analysis of 1,684 cases
Abstract
Background: Non-intubated video-assisted thoracoscopic surgery (NIVATS) has been increasingly used in lobectomy, bullectomy, wedge resection, lung volume reduction, sympathectomy and talc pleurodesis, which may reduce postoperative complications. However, the benefits of non-intubated and intubated methods of VATS remain controversial.
Methods: We comprehensively searched PubMed, Web of Science, Embase and the Cochrane Library, and performed a systematic review to assess the two techniques. Random and fixed-effects meta-analytical models were used based on the low between-study heterogeneity. Study quality, publication bias, and heterogeneity were assessed.
Results: Compared to intubated methods, NIVATS had a lower postoperative complications rate [odds ratio (OR): 0.63; 95% confidence interval (CI), 0.46–0.86; P<0.01], shorter global in−operating time [weighted mean difference (WMD): −35.96 min; 95% CI, −48.00 to −23.91; P<0.01], shorter hospital stay (WMD: −1.35 days; 95% CI, −1.72 to −0.98; P<0.01), shorter anesthesia time (WMD: −7.29 min; 95% CI, −13.30 to −1.29; P<0.01), shorter chest−tube placement time (WMD: −1.04 days; 95% CI, −1.75 to −0.33; P<0.01), less chest pain (WMD: −1.31; 95% CI, −2.45 to −0.17; P<0.05) and lower perioperative mortality rate (OR: 0.13; 95% CI, 0.02–0.99; P=0.05).
Conclusions: NIVATS is a safe, efficient and feasible technique for thoracic surgery and may be a better alternative procedure owing to its advantage in reducing postoperative complications rate, hospital stay, and chest pain.
Methods: We comprehensively searched PubMed, Web of Science, Embase and the Cochrane Library, and performed a systematic review to assess the two techniques. Random and fixed-effects meta-analytical models were used based on the low between-study heterogeneity. Study quality, publication bias, and heterogeneity were assessed.
Results: Compared to intubated methods, NIVATS had a lower postoperative complications rate [odds ratio (OR): 0.63; 95% confidence interval (CI), 0.46–0.86; P<0.01], shorter global in−operating time [weighted mean difference (WMD): −35.96 min; 95% CI, −48.00 to −23.91; P<0.01], shorter hospital stay (WMD: −1.35 days; 95% CI, −1.72 to −0.98; P<0.01), shorter anesthesia time (WMD: −7.29 min; 95% CI, −13.30 to −1.29; P<0.01), shorter chest−tube placement time (WMD: −1.04 days; 95% CI, −1.75 to −0.33; P<0.01), less chest pain (WMD: −1.31; 95% CI, −2.45 to −0.17; P<0.05) and lower perioperative mortality rate (OR: 0.13; 95% CI, 0.02–0.99; P=0.05).
Conclusions: NIVATS is a safe, efficient and feasible technique for thoracic surgery and may be a better alternative procedure owing to its advantage in reducing postoperative complications rate, hospital stay, and chest pain.
