Is video-assisted thoracic surgery justified at first spontaneous pneumothorax?

Abstract

The use of VATS at first spontaneous pneumothorax is justified in the interest of both patients and health administrations as demonstrated by the number of recurrences in patients in the first group and economy savings resulting from use of VATS.

Videothoracoscopic approach to recurrence primary spontaneous pneumothorax: using of electrocoagulation in small bulla/blebs

“…In this study, they reported that bullae resection with apical pleurectomy to be more effective than pleural abrasion at preventing recurrences [1]. Torresini and his colleagues practiced wedge resection with apical pleurectomy using endostapler on 35 patients with PSP among their 70 patients' series; and they reported that recurrence in only one (2.8%) patient within a short-term follow-up, and indicated that pleurectomy was an effective way of preventing recurrences [11]. Conversely, Lang-Landunski and his colleagues reported that wedge resection and abrasion on 182 PSP patients using polyglcholic mesh until they attain a bloody surface all over the pleura; and they reported recurrence at only three (1.6%) patients within long-term follow-up and thereby indicated pleural abrasion is to be an effective way of preventing recurrences [14].…”

“…However VATS, which has been used in every fi eld of thoracic surgery from the early 1990s, began to be used in recurrent PSP treatment commonly owing to its success results close to thoracotomy [9,10]. Shortened drainage and hospitalisation period, decreased morbidity, high patient compliance, less postoperative pain, less abnormality at shoulder movement and cosmetic advantages are the superiorities of VATS over thoracotomy [11][12][13].…”

Size of Pneumothorax can be a New Indication for Surgical Treatment in Primary Spontaneous Pneumothorax: A Prospective Study

“…For AT, an incision 5-6 cm in size was made from the border of the hairy area towards the anteriorinferior in the axillary region and mini-thoracotomy was performed through the 3rd intercostal space. 4) In VATS, the operation was performed through three ports, one of them being the tube thoracostomy site. In both procedures, apical segment of the upper lobe and superior segment of the lower lobe were examined in order to control for the presence of a bulla and/or a bleb.…”

“…4) Considering that the size of pneumothorax is directly proportional to the amount of air in the pleural space, the size of the pneumothorax may range from a small size which can be detected only by thoracic computed tomography (CT) scans to a total lung collapse. As the defect is larger in total lung collapse, ipsilateral recurrence or PAL is likely to occur more frequently in such cases.…”

Results of Mini Axillary Thoracotomy for Primary Spontaneous Pneumothorax

“…Cerrahi girişim endikasyonları; aynı tarafın ikinci pnömotoraksında, 5-7 günden uzun süren hava kaçağında, tüp torakostomiye rağmen akciğerin ekspanse olmaması ve toraks kavitesini doldurmamasıdır . Bazı otörler ise bilgisayarlı toraks tomografisinde (BT) apikalde blep ya da bül görüldüğünde, mesleki riski olanlarda ilk atakta dahi cerrahi tedavi önerme-ktedirler [3][4][5]. Pnömotoraks için yapılan operasyonlarda minimal invaziv tekniklerin kullanılması, hastanede yatış süresini kısaltması, daha estetik olması, düşük tedavi maliyeti ve yük-sek hasta konforu nedeni ile son yıllarda tercih edilir olmuştur.…”