This minimally invasive technique with the core feature of "tubeless" is redefining the operating paradigm of thoracic surgery, as it does not require tracheal intubation to maintain breathing, does not require thick chest tube drainage, and can remove auxiliary tubes in a short period of time after surgery. Recently, the reporter followed the "No Tube China Tour" promotional activity and visited Harbin Medical University Affiliated Cancer Hospital, a member unit of the Lung Tumor Early Screening and No Tube Minimally Invasive Technology Alliance, to investigate how this technology can help thoracic surgery bid farewell to "intubation dependence". In traditional thoracic surgery, endotracheal intubation and 28-36F thick chest tubes are standard, and these invasive procedures have a certain postoperative burden. Meng Qingwei, Vice President of Harbin Medical University Affiliated Cancer Hospital, introduced that the average hospitalization time for patients undergoing traditional thoracic surgery is 7-14 days after surgery, and they need to face problems such as discomfort in the throat caused by intubation and pain caused by chest tubes. The core of non-invasive minimally invasive technology is to minimize the intervention of invasive procedures on the patient's physiological system while ensuring surgical safety. ”Xu Hai, director of the lung ward of the thoracic surgery department at Harbin Medical University Affiliated Cancer Hospital, said. The key breakthrough of this technology lies in "de intubation", which not only eliminates the need for tracheal intubation to maintain breathing, but also reduces or removes chest tubes for drainage and urinary tubes for urination according to the situation. From a technical perspective, the tubeless minimally invasive technique has fundamentally adjusted the anesthesia plan. Huang Ning, Deputy Director of the Anesthesiology Department at Harbin Medical University Affiliated Cancer Hospital, introduced that traditional general anesthesia relies on three major elements: sedation, analgesia, and muscle relaxation. Among them, muscle relaxants can inhibit patients' spontaneous breathing, and patients must maintain intraoperative oxygen supply through tracheal intubation. In order to preserve the patient's spontaneous breathing function, the non-invasive minimally invasive technique "cut off" muscle relaxants and instead adopted a combination anesthesia regimen. The data shows that this technology can reduce the dosage of opioid analgesics and alleviate long-term coughing caused by airway irritation in postoperative patients. Through technological innovation, non-invasive technology has also accelerated the postoperative recovery process of patients. Since the patient does not require tracheal intubation, it avoids damage to the airway mucosa. Therefore, most patients who use this technology can be discharged 1-2 days after surgery, and some young patients can get out of bed and move around on the same day after surgery, which greatly improves bed turnover and alleviates the dilemma of "one bed difficult to find" in thoracic surgery. At the same time, tubeless minimally invasive technology has also reduced patients' medical costs. On the one hand, it saves the cost of consumables such as endotracheal intubation, and on the other hand, it shortens hospitalization time, significantly reducing overall medical expenses. This seemingly "simplified" technology actually puts higher technical requirements on medical teams, and its implementation relies on the deep collaboration of anesthesia and surgical techniques. Huang Ning introduced that thoracic anesthesia is a high difficulty field in surgical anesthesia, which requires doctors with 3-5 years of clinical experience to independently carry out. On this basis, a threshold is set for uncontrolled anesthesia - hospital regulations only allow doctors with associate senior or higher professional titles and more than 3 years of thoracic anesthesia experience to operate. Traditional anesthesia is' administered according to the procedure ', while uncontrolled anesthesia is' dynamically and precisely regulated', "Huang Ning explained. During surgery, doctors need to 'keep their eyes on the monitor' and adjust the depth of anesthesia for patients in real time. If patients cough or move, they need to immediately add analgesics; If the end tidal carbon dioxide partial pressure is too high, the risk should be reduced by adjusting respiratory parameters or assisting ventilation. For surgical teams, this technology requires doctors not only to be proficient in operation, but also to have precise control. Wang Junfeng, director of the third lung ward of the thoracic surgery department at Harbin Medical University Affiliated Cancer Hospital, told reporters that the growth cycle of thoracic surgeons is already 10-15 years, and the minimally invasive technology further requires doctors to have the ability to operate accurately in dynamic situations. Due to the patient retaining autonomous breathing function, the lungs will slightly sway with respiratory movements. Doctors need to predict the respiratory rate and amplitude, and complete precise cutting, hemostasis, and other operations within 1-2 seconds of breathing interval. The precision of the operation needs to be further improved. Meng Qingwei said that the significance of this technology lies not only in "minimally invasive" procedures, but also in enabling patients to shift from "fear of surgery" to "actively accepting treatment" through technological progress. (New Society)