Surgical techniques and outcome analysis of non-intubated uniportal VATS sleeve lobectomy: a cohort study

Abstract Background Non-intubated uniportal video-assisted thoracic surgery (NI-UVATS) has been introduced to further minimize invasiveness in lung resection. However, its feasibility and safety in complex procedures such as sleeve lobectomy remain underexplored. This study aimed to compare perioperative and early oncological outcomes between non-intubated and intubated UVATS for sleeve lobectomy. Methods We conducted a retrospective cohort study at a single center from March 2019 to July 2021, including patients undergoing UVATS sleeve lobectomy. Patients received either non-intubated spontaneous ventilation or intubated general anesthesia with a double-lumen tube. Perioperative outcomes, including operative time, blood loss, complications, and pathological results, were compared between groups. Results A total of 65 patients were analyzed (18 NI-UVATS, 47 I-UVATS). Baseline characteristics were similar, except for a slightly higher baseline PaCO2 (41.29 ± 3.16 vs. 39.15 ± 3.40 mmHg, p = 0.025) and lower serum albumin (36.22 ± 3.87 vs. 39.09 ± 3.57 g/L, p = 0.006) in the NI group. There were no conversions to intubation or thoracotomy in the NI group (0/18). Operative time (118.3 ± 19.2 vs. 107.3 ± 34.7 min, p = 0.180), estimated blood loss (median 50 mL in both, p = 0.310), and lymph node yield (13.2 ± 5.9 vs. 14.3 ± 8.5, p = 0.632) were comparable. Overall postoperative complication rates were similar (27.8% vs. 25.5%, p = 0.289), with prolonged air leak being the most common. No anastomotic complications or 90-day mortality occurred in either cohort. All surgical resections achieved an R0 margin. Conclusions In this cohort, NI-UVATS sleeve lobectomy was associated with comparable perioperative and pathological outcomes to the intubated approach in selected patients. This technique offers a less invasive anesthetic alternative without compromising surgical quality, supporting its consideration within enhanced recovery pathways for thoracic surgery.