A modified two-port thoracoscopic technique versus axillary minithoracotomy for the treatment of recurrent spontaneous pneumothorax: a prospective randomized study

Abstract

Axillary minithoracotomy and VATS are equally effective for the treatment of RSP, although the rate for resection of blebs, bulla, or both is higher with the axillary minithoracotomy procedure. Although VATS is more time consuming, it offers to the patient more satisfaction with treatment.

Management of Spontaneous Pneumothorax and Post-Interventional Pneumothorax: German S3 Guideline

“…The shorter stay in hospital after VATS could not be confirmed by all investigators [175,176]. Patient satisfaction is higher for VATS than for thoracotomy [156].…”

“…VATS has advantages over the open procedure, namely quicker mobilization [156], slighter early-postoperative pulmonary function limitations [142,170], shorter hospitalization time [158] and lower need for pain relievers [143,170,200]. These advantages are of especial importance for patients with SSP, limited lung function and multimorbidity.…”

Primary spontaneous pneumothorax: a cohort study of VATS with talc poudrage

“…Video-assisted thoracoscopic surgery (VATS) for pneumothorax is associated with a marked reduction in recurrence to around 3% 1. Without intervention, recurrence rates after primary spontaneous pneumothorax (PSP) are variably reported, with studies quoting rates as low as 26% and as high as 49% at 1 year 2 3.…”

Surgery for primary spontaneous pneumothorax

“…I could agree if one's compare VATS with standard open thoracotomy, however, the advantages of VATS over AMT concerning the cosmetic result are not so obvious, because the scar of AMT is very small and well hidden within the axilla. According to a prospective randomized study published in 2012, the main obvious advantage of VATS over AMT is the better patient satisfaction with treatment which it was connected with the earlier full dependent arm mobilization and the earlier return to full daily activities (7). The main technical advantage of VATS over AMT is the fact that the surgeon can proceed with subtotal pleurectomy if necessary, while pleurectomy with AMT is limited to the accessible through this small incision parietal pleura in the apex of the hemithorax.…”

“…Parietal pleurectomy of various extent (apical or subtotal or of any other extent), pleural abrasion, chemical pleurodesis with talc or other agent (i.e., povidone-iodine, as described in the commented article) are the acceptable and commonly employed techniques to perform pleurodesis (3)(4)(5)(6)(7)(8)13,14). Parietal pleurectomy is considered the best technique to achieve pleurodesis, however it has the disadvantage of possible bleeding resulting in the formation of clotted hemothorax (7). Another theoretical disadvantage of pleurectomy is the complete obliteration of the extrapleural plan in the area of pleurodesis which can make very hard any other future procedure within the operated hemithorax.…”