Thoracoscopic Surgery for Spontaneous Pneumothorax

Abstract

Spontaneous pneumothorax in apparently healthy individuals is a relatively common occurrence. The management of patients with spontaneous pneumothorax remains controversial. With the advances in thoracoscopic techniques and instrumentation, video-assisted thoracic surgery (VATS) is now accepted by many as the procedure of choice for surgical treatment of spontaneous pneumothorax. We report our combined experience with 757 patients who suffered from recurrent or persistent spontaneous pneumothorax treated by VATS over a 5-year period. Surgical indications included persistent air leak (n = 165), recurrence (n = 325), radiologically demonstrated huge bulla (n = 12), spontaneous hemopneumothorax (n = 13), incomplete expansion of the lung (n = 212), and bilateral involvement (n = 30). Several surgical procedures were undertaken, based on the thoracoscopic findings: endoscopic stapled bullectomy (n = 312), argon beam coagulation (n = 6), endoscopic suturing (n = 52), and endoloop ligation (n = 352). In 49 cases, mechanical or chemical pleurodesis was the only procedure performed. There were no mortalities or intraoperative hazards. Complications consisted of wound infections (n = 16), localized empyema (n = 2), chest wall bleeding (n = 1), and persistent air leaks (bulla type III) (n = 31). The median duration of the operation was 55 minutes (15-160 minutes), and the average postoperative hospital stay was 4.5 days (range 0-27 days). There were 16 recurrences (2.1%), after a mean follow-up of 30 months (range 1-60 months). Seven patients had recurrence from 9 to 17 months after stapled bullectomy. All the remaining patients had recurrence after failed pleurodesis. On the basis of our results, we conclude that video-assisted thoracoscopic management allows effective, safe performance of standard surgical procedures, avoiding a formal thoracotomy incision. We consider thoracoscopy the treatment of choice for patients with pneumothorax requiring surgical therapy.

Intraoperative, Postoperative and Long-Term Complications of VATS Treatment of Pneumothorax and Bullous Disease. A Review

“…The mean hospital stay ranges between 2.4-7.7 days and the morbidity rate ranges from 0 to 27.4% ( Table 1). Bleeding requiring reoperation have been reported by some authors [11,12,24,28,35], but the source of blood loss was undetectable in several cases. In our experience bleeding was due to the parietal pleurectomy and to the injury of muscular vessels caused by the introduction of thoracoports.…”

“…To resect blebs or bullae and to achieve pleurodesis several techniques have been described. The majority of the surgeons prefers endoscopic staplers to remove bullous parenchyma, but also endoscopic suturing [11,12], endoloop ligation [2,[11][12][13][14] and cautery [15][16][17][18] have been employed. Talc poudrage [19][20][21], pleural abrasion [15,[22][23][24][25], pleural argon beam coagulation [26] and partial pleurectomy [18,[27][28][29][30][31] are commonly performed to achieve pleurodesis.…”

Video-assisted thoracic surgery—The past, present status and the future

“…At present, VATS has gradually become the preferred procedure for most PSP and some SSP because of the much better treatment effects and lower recurrence rate when compared with tube drainage or aspiration, as well as its minimal invasiveness compared with open thoracotomy (Hatz et al, 2000;Loubani and Lynch, 2000). Therefore, VATS for SP will not only reduce morbidity but also in the long run reduce costs (Liu et al, 1999;Hatz et al, 2000;Luh et al, 1996;Casadio et al, 2002).…”

Video-assisted thoracoscopic surgery (VATS) for bilateral primary spontaneous pneumothorax

“…The secondary spontaneous pneumothorax (SSP) usually occurred in aged people and is combined with other pulmonary diseases such as COPD or tuberculosis (Luh et al, 2004). SP can occur bilaterally, either simultaneously or sequentially, in around 7.8% to 20% of patients surgically treated for SP (Baumann and Strange, 1997;Ikeda et al, 1988;Lang-Lazdunski et al, 2003;Liu et al, 1999;McCarthy et al, 1997;Watanabe et al, 2004). There were 54% to 88% of patients with unilateral SP being noted with contralateral bullous disease (Ikeda et al, 1988;Sihoe et al, 2000;Bertrand et al, 1996;Schramel et al, 1996).…”

“…Video-assisted thoracoscopic surgery (VATS) has been used for the re-section of bullae since the 1990s, and has gradually become the standard treatment for PSP (Melvin et al, 1992;Cardillo et al, 2000;Luh et al, 2004;Liu et al, 1999). Bilateral VATS for patients with simultaneously bilateral PSP is usually indicated.…”