Non-intubated VATS for lung cancer—a focus on segmentectomy: a narrative review

: Traditionally, lobectomy is the gold standard for early-stage non-small-cell lung cancer (NSCLC) treatment but in recent years lung segmentectomy is gaining a key role in small-sized or subsolid peripheral lung lesion <2 cm. It can be performed with minimally invasive approaches leading to better pulmonary function preservation, less postoperative pain and shorter hospitalization. Although for decades general anesthesia with tracheal intubation was considered mandatory, non-intubated video-assisted thoracic surgery (NiVATS) has been proposed as an alternative to traditional surgery. Its role in more challenging thoracoscopic procedures such as VATS anatomical lung resections is currently being evaluated. NiVATS applied to lung resections for early-stage NSCLC treatment, even if technically more challenging than conventional intubated thoracic surgery, is an innovative and promising surgical strategy allowing less intubation-related adverse effects and a faster recovery; several encouraging results have recently been reported, proving that minimally invasive surgical and anesthetic approaches could be a valid alternative to more invasive procedures in selected patients also in technical challenging anatomical resections. The aim of this review is to describe various technical aspects of NiVATS procedures and to investigate the combination of thoracoscopic segmentectomy and non-intubated anesthesia in terms of feasibility, safety, intra and perioperative complications, short-term outcomes and oncological adequacy.