Liu J, Liang H, Cui F, et al. - Given the reports of superior or equal efficacy of spontaneous ventilation video-assisted thoracic surgery (SV-VATS) vs mechanical ventilation VATS (MV-VATS) in terms of postoperative recovery, researchers sought to report on the perioperative safety of the SV-VATS blebectomy. They performed a non-inferiority, randomized controlled trial (NCT03016858) including 335 patients with primary spontaneous pneumothorax (PSP) (aged between 16-50 years) undergoing the SV-VATS or the MV-VATS. The SV-VATS group was linked with significantly reduced total dosage of intraoperative opioid agents and with shorter extubation time, postanesthesia care unit recovery time and food intake time, as well as with reduced anesthesia cost. Findings overall support the non-inferiority of the SV-VATS to the MV-VATS in terms of complication rate and in selected patients undergoing blebectomy for PSP.