Nonintubated surgery for lung biopsy delivers better outcomes in ILD patients

A recent study has shown the benefits of nonintubated video-assisted thoracic surgery (NIVATS), which offers better preservation of respiratory function, a good diagnostic yield, and improved overall outcomes after surgical lung biopsy in patients with interstitial lung disease (ILD) compared with intubated VATS (IVATS).

“NIVATS appears to be a promising technique with potentially lower morbidity compared with IVATS,” the researchers said. “However, larger prospective studies are needed to validate these findings.”

This single-centre retrospective study involved 61 patients who underwent lung biopsy for ILD diagnosis via VATS between January 2020 and September 2023 at Montpellier University Hospital in Montpellier, France. Researchers compared the clinical outcomes and diagnostic yield between IVATS and NIVATS.

The variation in pulmonary function tests following surgery (ie, forced expiratory volume in 1 sec [FEV1], forced vital capacity [FVC], and diffusing capacity of the lungs for carbon monoxide [DLCO]) was the primary outcome.

Of the patients, 26 (42 percent) underwent NIVATS. This group demonstrated a significantly smaller reduction in postoperative FEV1 and FVC than the IVATS group (p=0.001 for both variables). [Respirology 2025;30:949-956]

NIVATS also resulted in shorter operating room time (247 vs 288 min; p=0.013), hospital stay duration (47.5 vs 65.2 h; p=0.018), and reduced need for additional analgesics (3 percent vs 15 percent; p=0.001). Diagnostic yield, however, was comparable between NIVATS and IVATS, and no significant between-group differences were noted in DLCO or chest tube duration.

“Postoperative outcomes were similar to those reported in the literature, with significant improvements in operating room time, hospital stay duration, and a decrease in the need for additional analgesics in the NIVATS group,” the researchers said. [J Clin Med 2024;13:374; Eur J Cardiothorac Surg 2020;57:428-437; Respiration 2022;101:910-917]

Safety and feasibility

“These criteria contribute to accelerated recovery after … surgery, reducing the morbidity of NIVATS procedures, thus confirming the feasibility and safety of this technique in our centre,” they added.

Notably, 85 percent of patients in the NIVATS group had epidural anaesthesia, which potentially introduced bias in the management of postoperative analgesia. Thus, the NIVATS group had a lower need for rescue pain therapy, according to the researchers.

“Furthermore, the lack of difference in chest drainage duration, contrary to other studies, can be explained by the shorter drainage duration in both groups in this study,” they added. [ERJ Open Research 2021;7:00630-2020; J Thorac Dis 2018;10:3262-3268]

NIVATS also avoids complications associated with intubation and acute ventilation lung injury caused by mechanical ventilation, as well as adverse effects driven by the accumulation of hypnotic and opioid medications. [Am J Respir Crit Care Med 2020;201:767-774]

“This study adds additional data regarding the advantages of the NIVATS technique concerning respiratory function,” the researchers said. “It shows a statistically significant difference in pre- and postoperative FEV1 and FVC variation in favour of the NIVATS group.”