Complete Tubeless video-assisted thoracoscopic surgery for pulmonary nodules: association with faster recovery, less pain, and shorter hospital stay.

BACKGROUND

Conventional video-assisted thoracoscopic surgery (VATS) with intubation and chest drainage is associated with increased postoperative pain and delayed recovery. This retrospective, non-randomized comparative cohort study evaluated the safety and feasibility of a complete Tubeless VATS approach (spontaneous breathing with laryngeal mask anesthesia, without urinary catheter or chest tube) for peripheral pulmonary nodules in young and middle-aged patients.

METHODS

Between September 2022 and December 2023, 50 patients undergoing wedge or segmental resection for pulmonary nodules (≤3 cm) were enrolled. Twenty-five received Tubeless VATS (experimental group) and 25 received conventional VATS (control group). Perioperative outcomes included operative time, blood loss, time to first oral intake, hospital stay, anesthesia recovery time, visual analog scale (VAS) pain scores, PetCO2, SaO2, postoperative day 1 inflammatory markers [white blood cell count, neutrophil-to-lymphocyte ratio (NLR)], complications, and MD Anderson symptom inventory (MDASI) patient-reported outcomes (postoperative days 1-7 and weeks 2-4).

RESULTS

All 50 surgeries were successful without conversion to open surgery or endotracheal intubation. Compared with conventional VATS, Tubeless VATS was associated with significantly shorter time to first oral intake (5.12 ± 0.83 vs. 7.68 ± 1.11 h), shorter hospital stay (3.00 ± 1.04 vs. 4.84 ± 0.89 days), faster anesthesia recovery (11.12 ± 5.74 vs. 23.80 ± 5.82 min), lower VAS pain scores at all postoperative time points (P < 0.01), lower postoperative white blood cell count (10.67 ± 1.13 vs. 11.75 ± 1.62 × 10⁹/L), lower NLR (8.23 ± 2.48 vs. 9.85 ± 3.12), and fewer complications (8% vs. 32%, P = 0.034), with all conventional group complications being Grade I and predominantly related to intubation and catheterization. MDASI scores were better on days 1-5 (P < 0.05) but not thereafter. Maximum intraoperative PetCO2 was higher in the Tubeless group (51.20 ± 4.81 vs. 42.64 ± 2.99 mmHg, P = 0.023), with no significant difference in postoperative PaCO2 (44.08 ± 3.13 vs. 42.28 ± 3.97 mmHg, P = 0.082). Operative time and blood loss did not differ significantly between groups.

CONCLUSION

In selected young and middle-aged patients with peripheral pulmonary nodules ≤3 cm undergoing wedge or segmental resection, complete Tubeless VATS appears safe and feasible. It was associated with reduced postoperative pain, shorter hospital stay, lower inflammatory response, fewer complications, and improved early patient-reported outcomes, consistent with enhanced recovery after surgery principles. This Tubeless technique may represent a surgical innovation worthy of further evaluation in clinical practice.