Background: The safety profile and effect on inflammation of non-intubated video-assisted thoracoscopic surgery (NIVATS) remain incompletely understood. This study aimed to evaluate the safety of NIVATS and its effect on the inflammatory state. Methods: This single-center, randomized, parallel-controlled, double-blind trial enrolled patients with early-stage lung cancer scheduled for video-assisted thoracoscopic surgery in a Chinese tertiary center between September 2020 and October 2021. Patients were randomly assigned in a 1:1 ratio to undergo either NIVATS or intubated video-assisted thoracoscopic surgery (IVATS). Expression levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in blood samples, as well as expression levels of aquaporin-5 (AQP-5), surfactant protein A (SP-A), and high-mobility group box 1 (HMGB-1) in lung tissue samples, were measured. Total white blood cell (WBC) and neutrophil counts were determined using a cell counter. Results: Intergroup baseline characteristics of 120 included patients (NIVATS group: 60; IVATS group: 60) were comparable. In the NIVATS group, the level of HMGB-1 was decreased ( P = 0.03), while the levels of AQP-5 ( P 0.05). Additionally, on postoperative day 1 (WBC: 9.93 ± 0.42 vs. 11.85 ± 0.51 × 10 9 /L, P < 0.01; neutrophil: 74.37 ± 1.13% vs. 83.84 ± 0.94%, P < 0.01) and the day prior to discharge (WBC: 9.93 ± 0.42 vs. 11.85 ± 0.51 × 10 9 /L, P < 0.01; neutrophil: 66.99 ± 1.02% vs. 76.11 ± 1.09%, P < 0.01), the NIVATS group exhibited lower WBC and neutrophil counts compared to the IVATS group. Conclusions: NIVATS showed superiority over IVATS in maintaining intraoperative hemodynamic stability and reducing the postoperative inflammatory response. NIVATS may represent a safer and more advantageous option for patients with lung malignancies.
Wang et al. (2025) studied this question.