Comparison between Traditional Thoracotomy and Video-assisted Thoracoscopic Surgery: Anaesthetic Approach and Post-operative Analgesia

Abstract

Introduction: Thoracic surgery has undergone significant evolution with the widespread adoption of video-assisted thoracoscopic surgery (VATS), introducing specific anesthetic challenges, particularly regarding one-lung ventilation and postoperative analgesia. Objective: The review aims to compare the anesthetic implications of open thoracotomy and VATS, with emphasis on one-lung ventilation strategies and postoperative pain management. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. Clinical trials, observational studies, and systematic reviews comparing thoracotomy and VATS from an anesthetic perspective were included. Outcomes of interest comprised ventilatory strategies, intraoperative respiratory mechanics, postoperative pulmonary complications, and analgesic approaches. Results: VATS demonstrated a more favorable anesthetic profile compared with thoracotomy, including lower rates of postoperative pulmonary complications, better preservation of respiratory mechanics during one-lung ventilation, and reduced postoperative pain intensity. Protective ventilation strategies, characterized by low tidal volumes and individualized positive end-expiratory pressure, were associated with improved respiratory outcomes in both approaches. Additionally, multimodal analgesia and enhanced recovery protocols contributed to reduced opioid consumption and improved postoperative recovery, with more consistent benefits observed in VATS. Conclusion: When combined with contemporary anesthetic management, including protective one-lung ventilation and multimodal analgesia, VATS provides clinically meaningful advantages over open thoracotomy, resulting in reduced morbidity, improved respiratory outcomes, and enhanced postoperative recovery.