Treatment of patients with spontaneous pneumothorax during videothoracoscopy

Janssen, JP; Mourik, J. van; Valentin, Marcos; Sutedja, G.; Gigengack, K.; Postmus, P. E.

doi:10.1183/09031936.94.07071281

Cited by 23 publications

(16 citation statements)

References 12 publications

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“…The majority of studies regarding the treatment of pneumothorax through VATS usually make reference to spontaneous pneumothorax in general, without distinction between primary and secondary pneumothorax. Up to now, the data that have been published give figures that do not vary much, usually oscillating between 3 and 3.8% with respect to complications, and 0 to 7% with respect to relapses, with an average hospital stay of about 5 days [19][20][21][22][23]. As far as the treatment of PSP is concerned, similar results to our study have been published, with complication rates of 8% and relapses of 3% [24].…”

Section: Discussionsupporting

confidence: 78%

Surgical treatment of primary spontaneous pneumothorax with video-assisted thoracic surgery

Freixinet¹,

Canalís²,

Rivas³

et al. 1997

Eur Respir J

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We report the results of our experience using video-assisted thoracoscopic surgery (VATS) to treat primary spontaneous pneumothorax (PSP) from January 1992 until December 1994 in a multicentered co-operative study.A total of 132 patients (110 males and 22 females, aged 13-38 yrs, mean age 26 yrs) were treated by VATS to deal with the PSP that they presented with. A standard VATS technique was used. Apical bullae were always removed, and mechanical pleural abrasion was performed, leaving a pleural drainage tube.In two cases (1.5%), a switch to thoracotomy was necessary. In eight cases (6%), air leakage persisted for 5 days after surgery, which resolved with pleural drainage. There were eight postoperative relapses (6%), which were treated with pleural drainage (n=4), VATS (n=3) or axillar thoracotomy (n=1). The average postoperative stay was 5.6 days (range 2-15 days).We conclude that video-assisted thoracoscopic surgery is a viable alternative for the treatment of primary spontaneous pneumothorax. There is, however, a high relapse rate, and in a number of cases air leakage persists in the postoperative period. Eur Respir J 1997; 10: 409-411 Primary spontaneous pneumothorax (PSP) is a benign process, but persistent air leaks or recurrence make surgical intervention necessary in 30-40% of cases. PSP has come to be treated in the classic form, through axillar thoracotomy; the results published have been good, with a minimum rate of relapse and morbidity [1][2][3][4]. Recent developments in video-assisted thoracoscopic surgery (VATS) allowed a change in surgical technique, reducing surgical intervention. In order to evaluate VATS technique in PSP we initiated a multicentered study covering a period of 3 yrs. Materials and methodsBetween January 1992 and December 1994, a co-operative multicentered study was carried out by the Thoracic Surgery departments of three teaching hospitals. A total of 132 patients affected with PSP were treated by VATS. The indications for surgery for PSP were as follows: 1) persistent air leakage of more than 7 days after pleural drainage at the first episode of PSP (n=24); and 2) ipsilateral relapse in a case of PSP previously treated by pleural drainage (n=108). Cases of spontaneous pneumothorax, in which the patient had no primary pulmonary disease, were considered to have PSP.Patients treated through axillar thoracotomy during this same period of time were excluded from the study, as were patients with secondary pneumothorax, those more than 40 yrs of age (although not suspected of having basic pulmonary disease), and those of traumatic origin.The technique used was the same in all cases. It was carried out using general anaesthesia with a doublelumen endobronchial tube. Three incisions were made in order to introduce the optical equipment, the thoracic endoscopy instruments, and the endosutures. A removal of (generally apical) bullae or dystrophic complexes responsible for the episodes of pneumothorax was always performed. In cases of air leakage, air leak tests were performe...

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Section: Discussionsupporting

confidence: 78%

Surgical treatment of primary spontaneous pneumothorax with video-assisted thoracic surgery

Freixinet¹,

Canalís²,

Rivas³

et al. 1997

Eur Respir J

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“…Even after a follow-up time of 1 and 2 yrs, the recurrence rates after conservative treatment were significantly higher than after VATS. As stated in the literature [8][9][10], our study showed that VATS is more effective with a recurrence rate of 4%, less complications, shorter drainage and hospitalization time than pleural drainage or observation.…”

Section: Discussionsupporting

confidence: 68%

“…These bullae were considered large. Results of this approach have been published previously [10,18,19].…”

Section: Methodsmentioning

confidence: 97%

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Cost-effectiveness of video-assisted thoracoscopic surgery versus conservative treatment for first time or recurrent spontaneous pneumothorax

Schramel¹,

Sutedja²,

Braber³

et al. 1996

Eur Respir J

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C Co os st t--e ef ff fe ec ct ti iv ve en ne es ss s o of f v vi id de eo o--a as ss si is st te ed d t th ho or ra ac co os sc co op pi ic c s su ur rg ge er ry y v ve er rs su us sc co on ns se er rv va at ti iv ve e t tr re ea at tm me en nt t f fo or r f fi ir rs st t t ti im me e o or r r re ec cu ur rr re en nt t s sp po on nt ta an ne eo ou us s p pn ne eu um mo ot th ho or ra ax x Patients in both periods had comparable clinical characteristics. Irrespective of first time or recurrent spontaneous pneumothorax at presentation, drainage and hospitalization times were longer, and complication and recurrence rates were higher in Period 1. When costs due to the waiting time before VATS were excluded, the total costs in Period 1 were higher than in Period 2.Video-assisted thoracoscopic surgery is more effective in treating patients with first time or recurrent spontaneous pneumothorax, with less morbidity and total costs compared to conservative therapy. In view of cost-effectiveness, we feel that a different management of first time or recurrent spontaneous pneumothorax is not justified.

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“…(7) The indications for the intervention in cases of pneumothorax due to rupture of bullae or bullous emphysema are the same as those for performing the open procedure. These include recurrence or persistence (air leak for more than seven days) and a giant bulla that compresses the adjacent lung parenchyma, impairing its function.…”

Section: Introductionmentioning

confidence: 99%

Expectativas y satisfacción en el tratamiento del neumotórax espontáneo primario recurrente tratado por toracotomía o cirugía torácica video-asistida

Olavarrieta

Coronel

2009

J. bras. pneumol.

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Objective: To compare the outcomes of thoracotomy and video-assisted thoracoscopic surgery (VATS) in the treatment of recurrence of primary spontaneous pneumothorax. Methods: Medical records of patients presenting recurrence of primary spontaneous pneumothorax were retrospectively reviewed. Patients were divided into two groups: those who underwent conservative thoracotomy (n = 53, thoracotomy group); and those who underwent VATS (n = 47, VATS group). Results: Although there were no deaths in either group and the length of hospital stays was similar between the two, there was greater morbidity in the thoracotomy group. Patients in the thoracotomy group required more pain medication for longer periods than did those in the VATS group (p < 0.05). In the thoracotomy group, the rate of recurrence was 3%. Pain was classified as insignificant at one month after the operation by 68% of patients in the VATS group and by only 21% of those in the thoracotomy group (p < 0.05). At three years after the surgical procedure, 97% of the VATS group patients considered themselves completely recovered from the operation, compared with only 79% in the thoracotomy group (p < 0.05). Chronic or intermittent pain, requiring the use of analgesics more than once a month, was experienced by 90% of the thoracotomy group patients and 3% of the VATS group patients. In addition, 13% of the thoracotomy group patients required clinical pain management. Conclusions: We recommend VATS as the first-line surgical treatment for patients with recurrent primary spontaneous pneumothorax.Keywords: Thoracoscopy; Thoracic surgery, video-assisted; Recurrence; Pneumothorax. ResumenObjetivo: Comparar los resultados de la toracotomía con la video-assisted thoracoscopic surgery (VATS, cirugía torácica video-asistida) en el tratamiento de las recurrencias del neumotórax espontáneo primario. Métodos: Se revisaron los expedientes clínicos de los pacientes con neumotórax primario recurrente dividiéndose en dos grupos: pacientes sometidos a toracotomía (n = 53, grupo toracotomía) y pacientes sometidos a VATS (n = 47, grupo VATS). Resultados: La morbilidad fue mayor en el grupo A. Sin mortalidad en ninguno de los dos grupos. La duración de la hospitalización fue similar. Los pacientes del grupo toracotomía necesitaron más dosis de narcóticos durante períodos más largos de tiempo que los del grupo VATS (p < 0.05). Se presentó una recurrencia en el grupo toracotomía (3%). El 68% de los pacientes del grupo VATS y el 21% del grupo toracotomía clasificaron su dolor como insignificante transcurrido un mes de la cirugía (p < 0.05). A los tres años, el 97% de los sometidos a VATS se consideraron totalmente recuperados comparado con el 79% del grupo de toracotomía (p < 0.05). El 90% del grupo toracotomía y el 3% del grupo VATS se quejaban de dolor necesitando analgésicos por más de una vez al mes, 13% de los sometidos a toracotomía requirieron la asistencia de la clínica del dolor. Conclusiones: La VATS es la primera elección en el tratamiento de la recidiva del neum...

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Treatment of patients with spontaneous pneumothorax during videothoracoscopy

Cited by 23 publications

References 12 publications

Surgical treatment of primary spontaneous pneumothorax with video-assisted thoracic surgery

Surgical treatment of primary spontaneous pneumothorax with video-assisted thoracic surgery

Cost-effectiveness of video-assisted thoracoscopic surgery versus conservative treatment for first time or recurrent spontaneous pneumothorax

Expectativas y satisfacción en el tratamiento del neumotórax espontáneo primario recurrente tratado por toracotomía o cirugía torácica video-asistida

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