Non-intubated Spontaneous Ventilation Video-assisted Thoracoscopic Surgery For Spontaneous Pneumothorax:A Multicenter Randomized Trial

BackgroundSpontaneous ventilation video-assisted thoracic surgery(SV-VATS)is reported to have superior or equal efficacy on postoperative recovery to mechanical ventilation VATS(MV-VATS).However,perioperative safety of the SV-VATS blebectomy is not entirely demonstrated.MethodsWe performed a non-inferiority,randomized controll ed trial(NCT03016858)for primary spontaneous pneumothorax(PSP)patients between 16-50 years old undergoing the SV-VATS and the MV-VATS.The trial was conducted at 10 centers in China from April 2017 to January 2019.The primary outcome was the comparison of intra-and postoperative complications between the SV-VATS and the MV-VATS.Secondary outcomes included total analgesic dose,change of vital sign during surgery,procedural duration,recovery time,postoperative visual analogue pain scores,and hospitalization length.ResultsIn this study,335 patients were included.There was no significant difference between the SV-VATS group and the MV-VATS group in the intra-and postoperative complication rates(17.90% vs.22.09%;RR=0.81;95% CI 0.52-1.26;p=0.346).The SV-VATS group was associated with significantly decreased total dosage of intraoperative opioid agents: sufentanil(11.37 μg vs.20.92 μg;p<0.001)and remifentanil(269.78 μg vs.404.96 μg;p<0.001).The SV-VATS was also associated with shorter extubation time(12.28 min vs.17.30 min;p<0.001),post-anesthesia care unit recovery time(25.43 min vs.30.67 min;p=0.02)and food intake time(346.07 min vs 404.02 min;p=0.002).Moreover,the SV-VATS deceased the anesthesia cost compared with the MV-VATS(297.81 $ vs.399.81 $;p<0.001).ConclusionsThe SV-VATS has proved to be non-inferior to the MV-VATS in term of complication rate and in selected patients undergoing blebectomy for PSP.