{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:44:07Z","timestamp":1792806247940,"version":"4.5.0"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,7,1]],"date-time":"2022-07-01T00:00:00Z","timestamp":1656633600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:p>Non-intubated video-assisted thoracic surgery (NI-VATS) combines the advantages of a non-intubated surgery with the benefits of a minimally invasive approach. First, NI-VATS is performed in the case of fragile patients when general anesthesia and\/or orotracheal intubation can be foreseen as inconvenient. However, NI-VATS indications have been increasingly extended to different patient conditions, considering the increasingly assessed safety and feasibility of the procedure. Currently, the NI-VATS approach is used worldwide for different thoracic surgery procedures, including the management of malignant pleural effusion, surgical treatment of empyema, anatomical and non-anatomical lung resection, and other indications. In fact, this approach has shown to be less impactful than VATS under general anesthesia, allowing for shortened hospitalization and faster recovery after surgery. Besides, NI-VATS is associated with fewer pulmonary complications, less respiratory distress, and a mild systemic inflammatory reaction. For these reasons, this approach should be considered not only in patients with poor cardiac or respiratory function (general functional reserve), but also in other eligible conditions.<\/jats:p>\n                  <jats:p>We explored the anesthetic and surgical aspects of such an approach, including the management of analgesia, cough reflex, depth of sedation, and intraoperative technical issues to put this approach in perspective.<\/jats:p>","DOI":"10.3389\/fsurg.2022.937633","type":"journal-article","created":{"date-parts":[[2022,7,1]],"date-time":"2022-07-01T02:07:43Z","timestamp":1656641263000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":22,"title":["Non-Intubated Thoracic Surgery: Standpoints and Perspectives"],"prefix":"10.3389","volume":"9","author":[{"given":"Marco","family":"Anile","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacopo","family":"Vannucci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Ferrante","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katia","family":"Bruno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalila","family":"De Paolo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimiliano","family":"Bassi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Pugliese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Venuta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the NIVATS Interest Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,7,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1761","DOI":"10.1016\/j.athoracsur.2004.05.083","article-title":"Feasibility and results of awake thoracoscopic resection of solitary pulmonary nodules","volume":"78","author":"Pompeo","year":"2004","journal-title":"Ann Thorac Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"106","DOI":"10.3978\/j.issn.2305-5839.2014.10.01","article-title":"State of the art and perspectives in non-intubated thoracic surgery","volume":"2","author":"Pompeo","year":"2014","journal-title":"Ann Transl Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1016\/j.ejcts.2007.04.029","article-title":"Awake anaesthesia for major thoracic surgical procedures: an observational study","volume":"32","author":"Al-Abdullatief","year":"2007","journal-title":"Eur J Cardiothorac Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"40","DOI":"10.21037\/atm.2018.11.58","article-title":"Non-intubated thoracoscopic surgery for lung cancer in patients with impaired pulmonary function","volume":"7","author":"Wang","year":"2019","journal-title":"Ann Transl Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"99","DOI":"10.3978\/j.issn.2305-5839.2015.03.59","article-title":"Non-intubated thoracic surgery: nostalgic or reasonable?","volume":"3","author":"Pompeo","year":"2015","journal-title":"Ann Transl Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1111\/j.1365-2044.2008.05443.x","article-title":"Awake palliative thoracic surgery in a high-risk patient: one-lung, non-invasive ventilation combined with epidural blockade","volume":"63","author":"Guarracino","year":"2008","journal-title":"Anaesthesia"},{"key":"B7","doi-asserted-by":"publisher","first-page":"107","DOI":"10.3978\/j.issn.2305-5839.2015.04.15","article-title":"Effects on respiration of nonintubated anesthesia in thoracoscopic surgery under spontaneous ventilation","volume":"3","author":"Liu","year":"2015","journal-title":"Ann Transl Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1183\/09031936.02.00400802","article-title":"The lung and carbon dioxide: implications for permissive and therapeutic hypercapnia","volume":"20","author":"Kregenow","year":"2002","journal-title":"Eur Respir J"},{"key":"B9","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1016\/j.jtcvs.2013.03.038","article-title":"Dauri M; Awake Thoracic Surgery Research Group. Is there any benefit in using awake anesthesia with thoracic epidural in thoracoscopic talc pleurodesis?","volume":"146","author":"Pompeo","year":"2013","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1093\/ejcts\/ezv136","article-title":"Non-intubated video-assisted thoracoscopic lung resections: the future of thoracic surgery?","volume":"49","author":"Gonzalez-Rivas","year":"2016","journal-title":"Eur J Cardiothorac Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1632","DOI":"10.21037\/atm-21-4686","article-title":"Robotic-assisted non-intubated tracheal resection: the most excellent care or an unnecessary surgical challenge?","volume":"9","author":"Ferrari","year":"2021","journal-title":"Ann Transl Med"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.thorsurg.2019.09.001","article-title":"Technical Issues and Patient Safety in Nonintubated Thoracic Anesthesia","volume":"30","author":"Kiss","year":"2020","journal-title":"Thorac Surg Clin"},{"key":"B13","doi-asserted-by":"publisher","first-page":"R64","DOI":"10.1186\/cc5940","article-title":"Injurious mechanical ventilation in the normal lung causes a progressive pathologic change in dynamic alveolar mechanics","volume":"11","author":"Pavone","year":"2007","journal-title":"Crit Care"},{"key":"B14","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1097\/ACO.0b013e32835c4ea2","article-title":"Acute lung injury in thoracic surgery","volume":"26","author":"Della Rocca","year":"2013","journal-title":"Curr Opin Anaesthesiol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"957","DOI":"10.1213\/01.ane.0000172112.02902.77","article-title":"The pulmonary immune effects of mechanical ventilation in patients undergoing thoracic surgery","volume":"101","author":"Schilling","year":"2005","journal-title":"Anesth Analg"},{"key":"B16","doi-asserted-by":"publisher","first-page":"979","DOI":"10.1002\/ppul.22517","article-title":"Hyperoxia during one lung ventilation: inflammatory and oxidative responses","volume":"47","author":"Fisher","year":"2012","journal-title":"Pediatr Pulmonol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1016\/j.ejcts.2005.12.027","article-title":"The degree of oxidative stress is associated with major adverse effects after lung resection: a prospective study","volume":"29","author":"Misthos","year":"2006","journal-title":"Eur J Cardiothorac Surg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1097\/ALN.0b013e31825e6eb3","article-title":"Postoperative QT interval prolongation in patients undergoing noncardiac surgery under general anesthesia","volume":"117","author":"Nagele","year":"2012","journal-title":"Anesthesiology"},{"key":"B19","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1053\/j.jvca.2011.09.028","article-title":"Characterization of pulmonary and systemic inflammatory responses produced by lung re-expansion after one-lung ventilation","volume":"26","author":"Leite","year":"2012","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/1759-7714.12070","article-title":"From \u201cawake\u201d to \u201cmonitored anesthesia care\u201d thoracic surgery: A 15-year evolution","volume":"5","author":"Mineo","year":"2014","journal-title":"Thorac Cancer"},{"key":"B21","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1213\/ANE.0b013e3182742e75","article-title":"Postoperative residual neuromuscular blockade is associated with impaired clinical recovery","volume":"117","author":"Murphy","year":"2013","journal-title":"Anesth Analg"},{"key":"B22","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1016\/j.athoracsur.2010.04.070","article-title":"Impact of awake videothoracoscopic surgery on postoperative lymphocyte responses","volume":"90","author":"Vanni","year":"2010","journal-title":"Ann Thorac Surg"},{"key":"B23","doi-asserted-by":"publisher","first-page":"666","DOI":"10.1510\/icvts.2009.224139","article-title":"Surgical stress hormones response is reduced after awake videothoracoscopy","volume":"10","author":"Tacconi","year":"2010","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"B24","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1093\/icvts\/ivw055","article-title":"Non-intubated video-assisted thoracoscopic surgery under loco-regional anaesthesia for thoracic surgery: a meta-analysis","volume":"23","author":"Deng","year":"2016","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"B25","doi-asserted-by":"publisher","first-page":"7202","DOI":"10.21037\/jtd-20-2122","article-title":"Developing a minimally-invasive anaesthesiological approach to non-intubated uniportal video-assisted thoracoscopic surgery in minor and major thoracic surgery","volume":"12","author":"Starke","year":"2020","journal-title":"J Thorac Dis"},{"key":"B26","doi-asserted-by":"publisher","first-page":"769850","DOI":"10.3389\/fsurg.2021.769850","article-title":"Converting to Intubation During Non-intubated Thoracic Surgery: Incidence, Indication, Technique, and Prevention","volume":"8","author":"Chiang","year":"2021","journal-title":"Front Surg"},{"key":"B27","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1093\/ejcts\/ezu054","article-title":"Non-intubated thoracoscopic surgery using internal intercostal nerve block, vagal block and targeted sedation","volume":"46","author":"Hung","year":"2014","journal-title":"Eur J Cardiothorac Surg"},{"key":"B28","doi-asserted-by":"publisher","first-page":"61","DOI":"10.21037\/jovs.2016.02.22","article-title":"Anaesthetic considerations for non-intubated thoracic surgery","volume":"2","author":"Irons","year":"2016","journal-title":"J Vis Surg"},{"key":"B29","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1016\/j.thorsurg.2008.04.006","article-title":"Awake operative videothoracoscopic pulmonary resections","volume":"18","author":"Pompeo","year":"2008","journal-title":"Thorac Surg Clin"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.937633\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,11]],"date-time":"2022-08-11T11:04:16Z","timestamp":1660215856000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.937633\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,1]]},"references-count":29,"alternative-id":["10.3389\/fsurg.2022.937633"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2022.937633","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,1]]},"article-number":"937633"}}