BackgroundNon-intubated video-assisted thoracic surgery (NIVATS) avoids lung injury and intubation-related complications from mechanical ventilation, but the intraoperative safety and postoperative recovery quality of NIVATS remain controversial. Consequently, we systematically assessed the viability and safety of non-intubated video-assisted thoracic surgery (NIVATS) in comparison to intubated video-assisted thoracic surgery (IVATS). These findings provide evidence for optimizing anesthetic and surgical decision-making.MethodsPubMed, Web of Science, Embase, Cochrane Library, OVID, and Google Scholar were queried from their establishment until October 2024. We included eligible studies that compared non-intubated anesthesia with intubated anesthesia for video-assisted thoracoscopic surgery for thoracic conditions. Following the evaluation of bias risk in these randomized controlled trials (RCTs), a meta-analysis was conducted using Review Manager (Manager 5.4).ResultsNineteen randomized controlled trials were incorporated into the study. NIVATS demonstrated a reduced length of hospital stay, feeding time, and chest-tube dwell time compared to intubated methods. IVATS groups, hypoxemia exhibited a reduced incidence, but perioperative cough and perioperative arrhythmias revealed no statistically significant differences between IVATS and NIVATS groups. The NIVATS groups exhibited a significantly reduced risk compared to the IVATS groups for postoperative pulmonary complications (PPCs), postoperative nausea and vomiting (PONV), and sore throat.ConclusionsNIVATS avoid complications associated with intubation and are able to accelerate patient recovery to a certain extent. Although NIVATS carries intraoperative safety risks, careful patient selection can mitigate these risks.