Exploring Benefits of Non-Intubated Surgery for Lung Biopsy in Interstitial Lung Disease.

Abstract

Background and objectives: General anaesthesia with intubation is the standard technique for video-assisted thoracic surgery (VATS). However, non-intubated VATS (NIVATS) is emerging as a less invasive alternative, particularly for lung biopsies in patients with interstitial lung disease (ILD) and impaired respiratory function. This study aims to investigate the benefits of non-intubated surgery on postoperative respiratory function and to compare operative outcomes between intubated VATS (IVATS) and NIVATS.

Methods: We conducted a single-centre retrospective study of patients who underwent lung biopsy for ILD diagnosis via VATS between January 2020 and September 2023 at Montpellier University Hospital. Primary outcomes included the variation in pulmonary function tests after surgery (FEV₁, FVC, DLCO). Secondly, this study compares clinical postoperative outcomes and diagnostic yield between the two groups.

Results: The study included 61 patients, with 42% (n = 26) undergoing NIVATS. The NIVATS group showed a significantly smaller decrease in postoperative FEV₁ and FVC compared to the IVATS group (p = 0.001 for both variables). Additionally, NIVATS was associated with shorter operating room time (247 min vs. 288 min, p = 0.013), reduced hospital stay duration (47.5 h vs. 65.2 h, p = 0.018), and decreased need for additional analgesics (3% vs. 15%, p = 0.001). Diagnostic yield was at least similar to IVATS. There were no significant differences in DLCO or chest tube duration between the two groups.

Conclusions: NIVATS offers better preservation of respiratory function, a good diagnostic yield, and improved overall outcomes following surgical lung biopsy in patients with ILD and could be a preferred technique for diagnosis.