Background: Tubeless anesthesia for non-intubated uniportal video-assisted thoracoscopic surgery (NI-UniVATS) has been widely used in various thoracic surgical procedures. However, most patients selected for this procedure have a normal body mass index (BMI), and the impact of this surgery on patients with high BMI (H-BMI) remains unclear. The study aims to evaluate the perioperative course of NI-UniVATS in H-BMI patients.
Methods: A retrospective analysis was conducted on data from patients who underwent tubeless anesthesia for NI-UniVATS at The Affiliated Hospital of Hebei University between June 2023 and June 2025. A total of 414 eligible patients were included, with 38 in the H-BMI group (BMI ≥28 kg/m2) and 376 in the non-high BMI (NH-BMI) group (BMI <28 kg/m2). The intraoperative management and postoperative outcomes of the two groups were comprehensively compared.
Results: The clinical characteristics of the two groups were comparable, including age (P=0.78), gender (P=0.81), and surgical type (P=0.84). The number of intraoperative anesthetic adjustments was significantly higher in the H-BMI group than in the NH-BMI group (1.39±1.36 vs. 0.29±0.57, P=1×10-5). Intraoperative complications such as coughing (2.63%, P=0.31), hypercapnia (5.26%, P=0.15), and airway management due to laryngeal mask displacement (2.63%, P=0.31) occurred only in the H‑BMI group. No significant differences were observed between the two groups in mediastinal movement (34.21% vs. 15.78%, P=0.06), hypoxemia (10.52% vs. 2.63%, P=0.16), or intraoperative bleeding (5.26% vs. 7.89%, P=0.64). There were no statistically significant differences between the H-BMI group and the NH-BMI group in terms of operation time (122.05±55.55 vs. 110.92±47.45 min, P=0.41), intraoperative blood loss (10.63±10.98 vs. 13.95±17.67 mL, P=0.14), extubation (12.18±18.2 vs. 9.0±7.02 min, P=0.50), and post-anesthetic care unit recovery (32.18±12.07 vs. 34.11±19.43 min, P=0.74). Regarding postoperative pulmonary complications, in the H-BMI group, there were 4 cases (10.86%) of pleural effusion, 3 cases (7.89%) of atelectasis, and 2 cases (5.26%) of pneumothorax; in the NH-BMI group, the corresponding numbers were 2 cases (5.26%), 2 cases (5.26%), and 3 cases (7.89%). There were no statistically significant differences in chest drainage (500.26±553.80 vs. 521.32±523.40 mL, P=0.70), chest tube duration (3.68±2.37 vs. 3.74±2.79 days, P=0.95), postoperative discharge (4.87±2.52 vs. 4.45±2.69 days, P=0.31), and total costs (expressed in US dollars) (5,605.84±1,421.34 vs. 5,350.37±1,511.90, P=0.23) between the two groups.
Conclusions: Compared with NH-BMI patients, H-BMI patients undergoing NI-UniVATS have similar intraoperative conditions and postoperative outcomes, but require more intraoperative anesthetic adjustments.
Keywords: Tubeless anesthesia; high body mass index (high BMI); non-intubated uniportal video-assisted thoracoscopic surgery (NI-UniVATS).
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