Non-intubated video-assisted thoracic surgery: breaking down paradigms

The review written by Gonzalez-Rivas et al. [1] is delightful and informative on a recent and controversial topic: non-intubated thoracic surgery (NITS). As we all know, many of the current developments in different medical and surgical fields, e.g. minimally invasive, endovascular and others, are from proponents in Europe and Asia. Maybe, that is why American surgeons are reluctant to accept the evidence shown. At a recent conference at Duke in North Carolina, USA, Diego Gonzalez-Rivas presented his work and the audience of well-known surgeons dismissed the idea about the inconvenience of having conscious patients in the operating room [2].

Notwithstanding, Pompeo et al.'s [3] Survey of the European Society of Thoracic Surgeons showed a majority of respondents (59%) reported using non-intubated thoracic surgery procedures.

As we know, the NITS techniques are not new (they were described in the early 20th century) and remained useless for decades due to the intubated techniques, but the current research has demonstrated the feasibility, methods and good outcomes with NITS. Diego Gonzalez-Rivas said ‘the NTIS techniques could be the standard managenement of a subset of patients otherwise inoperable, and in the future to everyone’. There will have to be multicentric clinical trials of NITS with enough power to convince the sceptical surgeons to adopt NITS for the well-being of thoracic patients worldwide.

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