Tubeless uniportal VATS in thoracic surgery – Indications, ERAS pathways, and outcomes: A review

Tubeless uniportal video-assisted thoracoscopic surgery (VATS) is an innovative approach characterized by the use of non-intubated (spontaneous-breathing) anesthesia, the omission of routine postoperative chest drainage, and single-port access. This technique has gained traction in recent years for a variety of thoracic procedures. While practices reported in the literature may differ, this review primarily examines the combined non-intubated and drainless approach. This narrative review provides a comprehensive overview and critical analysis of its current clinical applications, including sympathectomy, pulmonary wedge resection, spontaneous pneumothorax, thymectomy, and early-stage lung cancer. It also addresses essential aspects of perioperative management and procedural indications within enhanced recovery-oriented pathways. A systematic literature search of PubMed, Embase, and Web of Science was conducted to identify pertinent studies published between January 2010 and April 2025. Current clinical reports indicate potential benefits such as reduced postoperative pain, shorter hospital stays, and accelerated recovery. However, the existing evidence largely stems from small, observational studies with varied methodologies, necessitating cautious interpretation. The broader implementation of this technique in more complex procedures depends on the establishment of standardized clinical pathways, the refinement of multidisciplinary perioperative strategies, and validation through multicenter prospective studies. Tubeless uniportal VATS shows promise as a significant advancement in function-preserving and recovery-oriented thoracic surgery.