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.

Background Various surgical protocols suggest the need for chest cavity exploration during surgical stabilization of rib fractures (SSRF) in the presence of a hemothorax (HTX). The aim of this study is to determine the outcome of patients who underwent SSRF with blind HTX evacuation vs. HTX washout under visual inspection. Methods This is a retrospective analysis of prospectively collected data from the Chest Injury International Database (CIID), a data repository of the Chest Wall Injury Society (CWIS) contributing members. Two cohorts were created: group VATS (SSRF with Video-Assisted Thoracic Surgery (VATS)) and group IOPI (SSRF with blind intra-operative pleural irrigation (IOPI)). The primary endpoint was chest tube days after SSRF. Secondary endpoints were pneumonia, mortality, Intensive Care Unit length of stay (ICULOS), hospital length of stay (HLOS), 30-day readmission, and mechanical ventilation days. Results A total of 276 patients were included (VATS n = 129; IOPI n = 147). Chest tube duration was shorter in the VATS group (VATS: 0[0−2], IOPI: 3[2−5]; p ' 0.001), while hospital length of stay was shorter in the IOPI group (VATS: 10.5[7−15], IOPI 7[5−10]; p ' 0.001). Mechanical ventilation was more frequent in the VATS group (VATS: n = 83/129, IOPI: n = 21/147; p ' 0.001), whereas ventilation duration was longer in the IOPI group (VATS: 1[1], IOPI: 4[2−10]; p ' 0.001). Mortality (p = 0.417), pneumonia (p = 0.842), readmission (p = 0.107), and ICU length of stay among ICU-admitted patients (p = 0.953) did not differ between groups. After adjustment for injury severity and pulmonary contusion burden, VATS remained independently associated with shorter chest tube duration, whereas hemothorax evacuation technique was not independently associated with hospital or ICU length of stay. Conclusion The use of VATS during SSRF was associated with shorter chest tube duration, and this association remained significant after adjustment for injury severity and pulmonary contusion burden. However, broader clinical outcomes were comparable between techniques. Level of evidence Therapeutic / Care Management; Level IV.