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This would be important as anaesthetic management of SV-VATS imposes fundamental changes to standards in thoracic anaesthesia and may increase anaesthetic risks. Therefore, this study aimed to provide such in-depth analysis and compare the results to data from matched intubated VATS (I-VATS) patients. 3D-reconstruction of bronchial airways helped to estimate the risk reduction by avoiding double-lumen tube (DLT) intubation according to common selection methods in SV-VATS patients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>SV-VATS patients receiving anatomical (<jats:italic>N<\/jats:italic>\u2009=\u200922) and non-anatomical (<jats:italic>N<\/jats:italic>\u2009=\u200916) lung cancer resections were prospectively enrolled. A retrospective I-VATS control cohort (<jats:italic>N<\/jats:italic>\u2009=\u200976) allowed for a 2:1 propensity score matching. DLT sizes necessary for SV-VATS patients according to common selection methods were evaluated by 3D-reconstruction of the left main bronchus and the \u2265\u20091\u00a0mm criterion.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>SV-VATS patients required substantially less propofol dosage (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) with an increase in variability of drug dosing (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and higher BIS values (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) as compared to I-VATS patients. SV-VATS lead to higher variability in respiratory parameters (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) with less driving pressure (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and similar mean tidal volumes, oxygenation, and hemodynamic parameters compared to I-VATS. Spontaneous ventilation was achieved by allowing for permissive hypercapnia and respiratory acidosis. Anaesthetic processing time was reduced by 7\u00a0min (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). 5\u201310% of female and 5% of male patients would have received a DLT larger than their bronchial airway.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Our study provides the first prospective quantitative in-depth analysis of a standardised anaesthetic management regime for SV-VATS, including anaesthetic processing times. Respiratory parameters during SV-VATS are compatible with reduced mechanical power as compared to patients undergoing I-VATS. The anaesthetic management regime reduced the risk of airway damage imposed by choosing too-large DLTs in up to 10% of patients without compromising oxygenation and hemodynamic stability. Changes in anaesthetic processing time by 7\u00a0min would not allow for a higher caseload of SV-VATS for lung cancer surgery.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical trial number<\/jats:title>\n            <jats:p>Not applicable.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12871-025-03027-9","type":"journal-article","created":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T11:25:26Z","timestamp":1744802726000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prospective in-depth analysis of anaesthetic management of spontaneous ventilation VATS for lung cancer resection: a matched pairs comparison to intubated VATS"],"prefix":"10.1186","volume":"25","author":[{"given":"Lorenz L.","family":"Mihatsch","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasia","family":"Huber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Weiland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Friederich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,16]]},"reference":[{"issue":"2","key":"3027_CR1","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1016\/j.ejcts.2007.04.029","volume":"32","author":"M Al-Abdullatief","year":"2007","unstructured":"Al-Abdullatief M, Wahood A, Al-Shirawi N, Arabi Y, Wahba M, Al-Jumah M, et al. 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