Construction and clinical validation study of a tubeless thoracoscopic surgery system based on the enhanced recovery after surgery concept

To evaluate the clinical efficacy of tubeless anesthesia combined with uniportal video-assisted thoracoscopic surgery (VATS) within an enhanced recovery after surgery (ERAS) protocol. A retrospective controlled study was conducted, including patients who underwent pulmonary resection between October 2023 and September 2024. Propensity score matching (PSM) was used to balance confounding factors. Anesthesia duration, hospital stay, incidence of postoperative complications, pain, and cough visual analogue scale (VAS) scores were compared between the two groups. A total of 72 patients undergoing lung surgery were enrolled. They were divided into the tubeless observation group (Group A) and the conventional double-lumen endotracheal intubation control group (Group B) based on whether double-lumen endotracheal intubation was performed. After propensity score matching, 15 pairs of patients were successfully matched, with no significant differences in baseline characteristics ( P > 0.05). None of the 30 patients experienced major bleeding, conversion to thoracotomy, reoperation, or perioperative death. There were no significant differences in complication rates and depression scores between the two groups ( P > 0.05). One patient in the control group developed ketoacidosis and coma postoperatively due to type 2 diabetes complications, received mechanical ventilation in the intensive care unit, and consequently had significantly prolonged hospitalization and higher costs compared to other patients in the same group. Statistically significant differences were observed between the two groups in anesthesia time, operation time, intraoperative blood loss, pain VAS score, cough VAS score, anxiety score, and early postoperative mobility (all P < 0.05), with the tubeless group demonstrating superior outcomes. In this small propensity-matched cohort, the tubeless technique was associated with reduced anesthesia time, decreased postoperative pain, and accelerated early functional recovery. These findings are preliminary and require confirmation in larger prospective studies.