Talcage by medical thoracoscopy for primary spontaneous pneumothorax is more cost-effective than drainage: a randomised study

Abstract

Simple thoracoscopic talcage (TT) is a safe and effective treatment of primary spontaneous pneumothorax (PSP). However, its efficacy has not previously been estimated in comparison with standard conservative therapy (pleural drainage (PD)).In this prospective randomised comparison of two well-established procedures of treating PSP requiring at least a chest tube, cost-effectiveness, safety and pain control was evaluated in 108 patients with PSP (61 TT and 47 PD).Patients in both groups had comparable clinical characteristics. Drainage and hospitalisation duration were similar in TT and PD patients. There were no complications in either group. The immediate success rate was different: after prolonged drainage (w7 days), 10 out of 47 PD patients, but only 1 out of 61 TT patients required a TT as a second procedure. Total costs of hospitalisation including any treatment procedure were not significantly different between TT and PD patients. Pain, measured daily by visual analogue scales, was statistically higher during the first 3 days in TT patients but not in those patients receiving opiates. One month after leaving hospital, there was no significant difference in residual pain or full working ability: 20 out of 58 (34%) versus 10 out of 47 (21%) and 36 out of 61 (59%) versus 26 out of 39 (67%) in TT versus PD groups, respectively. After 5 yrs of follow-up, there had been only three out of 59 (5%) recurrences of pneumothorax after TT, but 16 out of 47 (34%) after conservative treatment by PD. Cost calculation favoured TT pleurodesis especially with regard to recurrences.In conclusion, thoracoscopic talc pleurodesis under local anaesthesia is superior to conservative treatment by chest tube drainage in cases of primary spontaneous pneumothorax that fail simple aspiration, provided there is efficient control of pain by opioids.

Short-term safety of thoracoscopic talc pleurodesis for recurrent primary spontaneous pneumothorax: a prospective European multicentre study

“…One or two entry ports were used to insert the videothoracoscope and the pneumatic atomiser. 2 g of graded talc (Steritalc1; Novatech, La Ciotat, France) were gently insufflated under visual control over the entire pleural surface [21]. Graded talc is characterised by the particle size, which has to be .10 mm and should contain only a small percentage of smaller particles.…”

Spontaneous Pneumothorax Treatment Modalities: A Study of 48 Cases

“…Talk, plöredez için kullanılan en ucuz ve etkili ajanlardan biridir ve tüm kimyasal ajanlar içinde en düşük nüks oranına sahiptir. [37,38] Talk ile plöredez uygulamasında akut yan etkiler arasında, solunum yetmezliği ve ölüm gibi komplikasyonlar tarif edilmiştir. [39,40] Ancak 659 olgu ile yapılan kapsamlı bir diğer çalışmada talk nedeniyle gelişen akut solunum yetmezliği oranı %0.15 olarak raporlanmıştır.…”

Advanced medical interventions in pleural disease

“…Once more, whilst this has conventionally been the realm of the thoracic surgeon, medical thoracoscopy has been successfully used to treat patients with spontaneous pneumothorax. A RCT comparing medical thoracoscopic talc poudrage with standard conservative pleural drainage in 108 patients with primary spontaneous pneumothorax demonstrated improved clinical and economic outcomes for those patients who underwent thoracoscopy [134]. A smaller prospective case series of 41 patients with secondary spontaneous pneumothorax also reported favourably with low rates of recurrence and peri-procedural morbidity and mortality [135].…”