Awake non-intubated thoracic surgery: an attempt of systematic review and meta-analysis

Luca Bertolaccini, Gino Zaccagna, Duilio Divisi, Alessandro Pardolesi, Piergiorgio Solli, Roberto Crisci


The challenge of surgeons in our era is a less-invasive procedure. Over the last 20 years, video assisted thoracic surgery (VATS) become the treatment of choice in multiple chest related illnesses. Usually, VATS requires general anaesthesia with the selective intubation. However, in severe patients, with a high comorbidity index or elevated risk for anaesthesia, general anaesthesia may not be possible. An alternative is to perform the VATS in patients under local anaesthesia, awake, and non-intubated. We conducted an attempt of systematic literature review and meta-analysis of non-intubated VATS (AVATS) focusing attention on mortality rate, the complications and the hospital length of stay. AVATS is a feasible and safe technique that is increasingly aware of the possibility of applying for surgery even patients with high indexes of comorbidity, reduced cardiovascular function and general conditions contraindicating general anaesthesia. Nevertheless, further investigations are required to confirm these findings.