Nonintubated Versus Intubated Uniportal Thoracoscopic Segmentectomy for Lung Tumors

Abstract

Background: Although the use of the uniportal thoracoscopic technique has spread exponentially recently, a comparison of nonintubated and intubated uniportal thoracoscopic segmentectomies for lung tumors has not been reported. We aimed to compare the feasibility, safety, and short-term postoperative outcomes between the 2 methods.

Methods: From January 2014 to June 2019 we retrospectively reviewed 185 consecutive patients with lung tumors who underwent uniportal thoracoscopic segmentectomy at our institute. A body mass index of ≥25 kg/m² was considered a contraindication for the nonintubated anesthetic approach. For the remaining cases the anesthetic approach was made at the discretion of each individual anesthesiologist. A propensity-matched analysis incorporating sex and body mass index was used to compare the clinical outcomes of the nonintubated and intubated groups.

Results: Fifty patients (27.0%) underwent the procedure with the nonintubated anesthetic approach. The nonintubated group was more likely to be female (P < .001) and with a lower body mass index (P < .001). Other clinical features showed no significant difference. There was no significant difference between the 2 groups in the type of segmentectomy according to the difficulty classification system. After propensity matching 43 matched patients in each group were included. Anesthetic induction duration (12.0 vs 15.3 minutes, P = .014) was shorter in the nonintubated group. No other significant differences in perioperative, postoperative, and anesthetic results were noted between the 2 matched groups.

Conclusions: The nonintubated anesthetic approach can be a safe and feasible alternative to intubated uniportal thoracoscopic segmentectomy.