Summary

The consensus outlines tubeless video-assisted thoracic surgery (VATS) as an evolving minimally invasive surgical strategy for managing pulmonary ground-glass nodules (GGNs) detected increasingly through low-dose CT screening. GGNs may be benign or represent early-stage lung cancer, and surgical resection via VATS is often needed for diagnosis and treatment. Tubeless VATS refers to non-intubated VATS with spontaneous ventilation, where general endotracheal intubation, postoperative chest tubes, and urinary catheters are all avoided to reduce trauma, minimize pain, and enhance recovery compared with traditional intubated, mechanically ventilated approaches. It is most applicable for wedge or sublobar resections of peripheral GGNs, with careful patient selection based on factors such as good performance status, controlled comorbidities, and appropriate pulmonary function. The protocol also details anesthesia techniques (for example, use of laryngeal mask airway with regional blocks), intraoperative management, criteria for conversion to intubated surgery when necessary, and postoperative care emphasizing early mobilization and monitoring for complications such as atelectasis or pneumothorax. While tubeless VATS shows promise in reducing postoperative morbidity and facilitating faster recovery, the consensus highlights the need for experienced surgical and anesthesia teams and careful intraoperative decision-making to ensure patient safety.

Full article: Tubeless video-assisted thoracic surgery for pulmonary ground-glass nodules: expert consensus and protocol (Guangzhou) - PMC

He, J., Liang, H., Wang, W., Akopov, A., Aiolfi, A., Ang, K., Bertolaccini, L., Cai, K., Cao, Q., Chen, B., Chen, C., Chen, C., Chen, D., Chen, F., Chen, J., Chen, L., Chen, M., Chen, Y., Chen, Z., Cheng, C., Cui, D., Cui, F., Dai, T., Dong, Q., Ferrari, P., Flores, R., Fu, J., Funaki, S., Froudarakis, M., Gan, X., Geng, M., Guo, J., Guo, Q., Han, Y., He, J., He, K., Hirai, K., Hu, J., Hu, S., Huang, J., Huang, J., Jiang, W., Kim, K., Kiss, G., Kong, F., Lan, L., Leng, X., Li, B., Li, G., Li, H., Li, H., Li, H., Li, J., Li, X., Li, S., Li, Y., Li, Z., Liang, Y., Liang, L., Liang, W., Liao, Y., Lin, W., Lin, X., Liu, H., Liu, H., Liu, J., Liu, J., Liu, X., Liu, Z., Lu, X., Luo, Q., Mao, N., Pan, Q., Pang, D., Peng, J., Peng, J., Pompeo, E., Qian, R., Qiao, K., Redwan, B., Sang, Z., Shao, W., Shen, J., Shen, W., Sung, S., Tang, W., Wang, T., Wang, G., Wang, H., Wang, H., Wang, J., Wang, W., Wang, Y., Wang, Z., Wei, L., Wei, W., Wu, H., Wu, J., Xia, Z., Xu, C., Xu, E., Xu, H., Xu, N., Xu, Q., Xu, R., Xu, S., Yang, C., Yang, H., Yang, S., Yi, J., Zhang, G., Zhang, H., Zhang, J., Zhang, M., Zhang, X., Zhang, Y., Zhang, Z., Zhang, Z., Zhao, H., Zhao, J., Zhao, X., Zhou, J., Zhou, Y., Zhu, C., Zhu, S., Zhu, X., Cui, J., Yan, Y., & Chen, K. (2021). Tubeless video-assisted thoracic surgery for pulmonary ground-glass nodules: expert consensus and protocol (Guangzhou). Translational Lung Cancer Research, 10(8), 3503-3519. doi:10.21037/tlcr-21-663