{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T05:01:52Z","timestamp":1780030912132,"version":"3.53.1"},"reference-count":29,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T00:00:00Z","timestamp":1776038400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T00:00:00Z","timestamp":1776038400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Non\u2010intubated video\u2010assisted thoracoscopic surgery (VATS) with sedation anesthesia (SA) has emerged as an alternative to general anesthesia (GA) with tracheal intubation for pulmonary spontaneous ventilation anesthesia. Its safety and perioperative efficacy remain incompletely defined. We also considered oncologic quality metrics, including margins and nodal evaluation, when spontaneous ventilation anesthesia was performed for suspected or confirmed malignancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI) were systematically searched through June 2025. Eligible studies compared SA (nonintubated, spontaneous ventilation) with GA using either double\u2010lumen or single\u2010lumen tubes with bronchial blockers (pooled as \u201cintubated GA\u201d). Primary outcomes were overall procedural time (induction\u2009+\u2009operation\u2009+\u2009emergence), postoperative length of stay (LOS), and perioperative complications. Secondary outcomes included operative duration. Random\u2010effects models were applied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seventy\u2010five studies were screened; five comparative studies (112 SA; 119 GA) met criteria. Overall procedural time favored SA (SMD \u22120.39, 95% CI \u22120.68 to \u22120.09), whereas induction time showed no significant difference (SMD \u22120.11, 95% CI \u22120.37 to 0.15). LOS was shorter with SA (SMD \u22121.41, 93% CI \u22122.65 to \u22120.16) but showed high heterogeneity across enhanced recovery adoption and discharge policies. Complication rates were comparable, and operative duration showed a nonsignificant trend favoring SA. Stratification by indication or GA technique was not feasible.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>SA is a feasible alternative to intubated GA for VATS spontaneous ventilation anesthesia, potentially reducing procedural time and LOS without raising complication risk. Applicability to U.S. practice requires caution, given oncologic standards and lower adoption. Prospective randomized trials with standardized endpoints remain necessary.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ans.70545","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T11:49:49Z","timestamp":1776080989000},"page":"1094-1100","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Non\u2010Intubated (Sedation) Versus Intubated General Anesthesia for\n                    <scp>VATS<\/scp>\n                    Pulmonary Spontaneous Ventilation Anesthesia: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"96","author":[{"given":"Daiyuan","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Anesthesiology Renmin Hospital, Hubei University of Medicine  Shiyan Hubei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Xi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Renmin Hospital, Hubei University of Medicine  Shiyan Hubei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyuan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Renmin Hospital, Hubei University of Medicine  Shiyan Hubei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5155-5041","authenticated-orcid":false,"given":"Zhenzhen","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Renmin Hospital, Hubei University of Medicine  Shiyan Hubei China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,13]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/imi.0b013e3181662c6a"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semtcvs.2012.06.010"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3182742e75"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e31825683dc"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2019.02.012"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2016.04.39"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2004.05.083"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e31822ed19b"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2010.06420.x"},{"issue":"8","key":"e_1_2_11_11_1","first-page":"110","article-title":"Nonintubated Anesthesia in Thoracic Surgery: General Issues","volume":"3","author":"Kiss G.","year":"2015","journal-title":"Annals of Translational Medicine"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezu054"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/1553350614531662"},{"issue":"1","key":"e_1_2_11_14_1","first-page":"37","article-title":"Analysis of Feasibility and Safety of Complete Video\u2010Assisted Thoracoscopic Resection of Anatomic Pulmonary Segments Under Non\u2010Intubated Anesthesia","volume":"6","author":"Guo Z.","year":"2014","journal-title":"Journal of Thoracic Disease"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2018.06.163"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2018.05.147"},{"key":"e_1_2_11_17_1","unstructured":"National Comprehensive Cancer Network \u201cNCCN Clinical Practice Guidelines in Oncology: Non\u2010Small Cell Lung Cancer \u201dVersion 5.2024 https:\/\/www.nccn.org\/guidelines."},{"key":"e_1_2_11_18_1","unstructured":"Commission on Cancer Optimal Resources for Cancer Care (2020 Standards) \u201cStandard 5.8: Pulmonary Resection American College of Surgeons \u201d2020."},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezv136"},{"key":"e_1_2_11_20_1","article-title":"Transparency in the Reporting of Artificial INtelligence the TITAN Guideline","volume":"10","author":"Agha R. 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