Comparative analysis of safety and outcomes of Non-intubated versus intubated uniportal video-assisted thoracic surgery using propensity score matching: a single-center experience expanding indications beyond traditional restrictions

Background: Non-intubated uniportal video-assisted thoracoscopic surgery (NI-UVATS) has emerged as an alternative to conventional intubated approaches, yet its applicability across diverse patient populations and procedure types remains undefined. We evaluated perioperative outcomes of NI-UVATS vs. intubated UVATS (I-UVATS) in an unrestricted cohort. Methods: stratification by procedural complexity was conducted. Results: = 0.291). Conclusions: NI-UVATS demonstrated safety and feasibility for low-to-medium complexity thoracic procedures within current real-world selection patterns. The marked procedural imbalance (36.7% vs. 5.1% anatomical resections) reflects contemporary practice where surgeons reserve NI-UVATS for lower-complexity interventions. These findings support NI-UVATS implementation for appropriately selected patients undergoing diagnostic and pleural procedures, while anatomical resections remain predominantly performed under intubation. Procedure-specific randomized trials are needed to define the role of NI-UVATS in complex resections.