Cold coagulation in thoracoscopic treatment of primary pneumothorax: a comparison with apicectomy

Abstract

Objectives Primary spontaneous pneumothorax is a common disease, whose surgical treatment is still enigmatic in terms of timing and technique. Herein, we reported our experience with the parenchymal sparing technique via cold coagulation, in comparison to stapler apicectomy. Methods We retrospectively collected data of all patients with apical blebs or < 2cm bullae treated with minimally invasive surgery for recurrent or persistent spontaneous pneumothorax, from 2010 to 2020. Two different surgical techniques were used: stapler apicectomy and the parenchymal sparing cold coagulation of the apex. Perioperative and long-term results were analysed and compared. Results Out of 177 patients enrolled, 77 patients (CC-group) underwent cold-coagulation of the apex while 100 patients (SA-group) were treated with stapler apicectomy. Two groups were comparable in terms of age, surgical indication, intraoperative findings and affected side. CC-group had a mean operative time of 43.2 min (SD ± 19.5), shorter than SA-group with 49.3 min (SD ± 20.1, p-value : 0.050). Complications rate was significantly different between two groups, 5 (7%) and 16 (16%), for CC- and SA-group, respectively (p : 0.048), even if not in term of prolonged post-operative air-leak (p : 0.16). During the follow-up, 13 homolateral recurrences were reported: 2 (3%) in group CC and 11 (11%) in group SA; with a significant difference (p : 0.044). All reinterventions (post-operative prolonged air-leak and recurrences) required a stapler apicectomy. Conclusions Parenchymal sparing technique through cold coagulation of apical blebs and bullae is an effective treatment for primary spontaneous pneumothorax and guarantees a good immediate lung sealing, despite stapling still represents the choice treatment in complex cases.