Nonintubated versus intubated thoracoscopic bullectomy for primary spontaneous pneumothorax: A multicenter propensity-matched analysis

Ahmed G. Elkhouly, Yekta Altemur Karamustafaoglu, Carlos Galvez, Madhuri Rao, Philip Lerut, Annelies Grimonprez, Firas Abu Akar, Michael Peer, Benedetta Bedetti, Davide Tosi, Akif Turna, Mohamed Elkahwagy, Eugenio Pompeo

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: We aimed at comparing in a multicenter propensity-matched analysis, results of nonintubated versus intubated video-assisted thoracic surgery (VATS) bullectomy/blebectomy for primary spontaneous pneumothorax (PSP). Methods: Eleven Institutions participated in the study. A total of 208 patients underwent VATS bullectomy by intubated (IVATS) (N = 138) or nonintubated (NIVATS) (N = 70) anesthesia during 60 months. After propensity matching, 70 pairs of patients were compared. Anesthesia in NIVATS included intercostal (N = 61), paravertebral (N = 5) or thoracic epidural (N = 4) block and sedation with (N = 24) or without (N = 46) laryngeal mask under spontaneous ventilation. In the IVATS group, all patients underwent double-lumen-intubation and mechanical ventilation. Primary outcomes were morbidity and recurrence rates. Results: There was no difference in age (26.7 ± 8 vs 27.4 ± 9 years), body mass index (19.7 ± 2.6 vs 20.6 ± 2.5), and American Society of Anesthesiology score (2 vs 2). Main results show no difference both in morbidity (11.4% vs 12.8%; p = 0.79) and recurrence free rates (92.3% vs 91.4%; p = 0.49) between NIVATS and IVATS, respectively, whereas a difference favoring the NIVATS group was found in anesthesia time (p < 0.0001) and operative time (p < 0.0001), drainage time (p = 0.001), and hospital stay (p < 0.0001). There was no conversion to thoracotomy and no hospital mortality. One patient in the NIVATS group needed reoperation due to chest wall bleeding. Conclusion: Results of this multicenter propensity-matched study have shown no intergroup difference in morbidity and recurrence rates whereas shorter operation room time and hospital stay favored the NIVATS group, suggesting a potential increase in the role of NIVATS in surgical management of PSP. Further prospective studies are warranted.

Original languageEnglish (US)
Pages (from-to)1010-1016
Number of pages7
JournalAsian Cardiovascular and Thoracic Annals
Issue number9
StatePublished - Nov 2022

Bibliographical note

Publisher Copyright:
© The Author(s) 2022.


  • VATS
  • nonintubated anesthesia
  • primary spontaneous pneumothorax
  • spontaneous ventilation
  • thoracoscopy
  • Humans
  • Treatment Outcome
  • Pneumothorax/diagnostic imaging
  • Drainage
  • Young Adult
  • Adolescent
  • Adult
  • Thoracic Surgery, Video-Assisted/adverse effects
  • Retrospective Studies

PubMed: MeSH publication types

  • Journal Article
  • Multicenter Study


Dive into the research topics of 'Nonintubated versus intubated thoracoscopic bullectomy for primary spontaneous pneumothorax: A multicenter propensity-matched analysis'. Together they form a unique fingerprint.

Cite this