Unilateral single-port thoracoscopic surgery for bilateral pneumothorax or pulmonary bullae

Abstract

Background Rapid rehabilitation surgery has become a widely accepted approach. Thoracic surgeons have attempted in many ways to make surgery less invasive. We combined tubeless technology, single-port technology and mediastinum approach for the treatment of simultaneous bilateral primary spontaneous pneumothorax(PSP)or pulmonary bullae. And we evaluated its therapeutic effect. This study aimed to investigate if tubeless single-port video-assisted thoracic surgery (Tubeless-SPVATS) via anterior mediastinum can be used as an alternative surgical treatment for bilateral lung diseases, especially for concurrent or contralateral recurrence PSP. Methods From November 2014 to December 2016, 18 patients with simultaneous bilateral PSP or pulmonary bullae were treated with tubeless -SPVATS via anterior mediastinum. They were 13 males and 5 females with an average age of 20.2 ± 2.3 years (17 to 24 years). They all had preoperative chest CT and were diagnosed with simultaneous bilateral PSP or pulmonary bullae. Results Fifteen patients underwent bilateral bullae resection with Tubeless-SPVATS via anterior mediastinum. Three patients underwent bilateral single-port video-assisted thoracic surgery. No thoracotomy was performed. No death and grade 3-4 mobidity were found. All the patients started eating 6 hours after surgery. The average operation time was 44.56±17.8min. The patients were discharged 3. 5±1.0 days postoperatively. Conclusions Tubeless-SPVATS via anterior mediastinum is a safe and feasible treatment for patients with simultaneous bilateral PSP or pulmonary bullae. However,contralateral thoracic is not explored fully enough. And when contralateral lung bullae are located near the hilum, endoscopic linear stapler cannot be easily used to conduct suture. Thus, the recurrence rate after performing Tubeless-SPVATS may be increased compared to performing thoracotomy. However, compared to bilateral thoracic surgery, this method reduced postoperative pain. And it took significantly less time than bilateral thoracic surgery. Thus, this method has some clinic value.

Simultaneous bilateral thoracoscopic blebs excision reduces contralateral recurrence in patients undergoing operation for ipsilateral primary spontaneous pneumothorax

“…International consensus recommends surgical intervention after the first ipsilateral or contralateral recurrence, as mentioned in the leading guidelines. 2,14,15 Although some literature advocates early surgery for patients presenting with blebs or bullae after a first episode of PSP, 4,[16][17][18] as well as some physicians proving the feasibility and safety of performing single-stage unilateral or bilateral video-assisted thoracic surgery (VATS) in selected patients with PSP with contralateral blebs/bullae using different techniques, [19][20][21][22][23][24] the effect of contralateral bleb excision in the prevention of contralateral recurrence with the same anesthesia for ipsilateral PSP remains controversial. No study or follow-up data show the outcome or effect of the contralateral surgery.…”

Application of bilateral simultaneous sequential single-incision video-assisted thoracic surgery in multiple nodules both lungs: a single-center experience of 10 cases

“…Lunxu Liu, from the Department of Thoracic Surgery of West China Hospital of Sichuan University, demonstrates the value of single-port thoracoscopic surgery in treating multiple primary lung cancers in 2014. Further exploration of this method after this, the majority of the lesions involved bilateral lungs disease like bilateral isolated metastases [ 14 ], bilateral pulmonary bullae with unilateral/bilateral pneumothorax and lung volume reduction surgery for patients with severe emphysema [ 15 ]. And may involve empyema [ 16 ], bilateral pleural biopsies, bilateral thoracic sympathectomy [ 17 , 18 ] and thymoma complicated with myasthenia gravis, etc.…”

“…The rationale for selection was based on surgical operator’ own clinical experience. After we managed the journals searches [ 2 – 7 , 9 , 14 , 15 , 17 – 24 ] and summaries of related work experience in our department, there are several caveats to our study that are noted throughout and summarized below. Such patients without a complicating pleural infection, thoracic trauma with hemopneumothorax and rib fractures, a history of prior pleurodesis or any subtle pleural nodularity or thickening is found on preoperative chest CT scans; With appropriate monitoring of cardiopulmonary parameters it can be performed safely and is well tolerated.…”

“…With the range operative indications for subxiphoid surgical window, it avoids the change of position during the bilateral operation and increases the duration of surgery and anesthesia to some extent, also has some advantages [ 15 , 21 ], and we hope their superior and inferior will be confirmed by a larger study. The treatment by a combination of ablation procedure ablative therapy, stereotactic radiotherapy and surgery [ 23 , 25 ] may minimize the risk of surgical adverse events.…”

Expert consensus on spontaneous ventilation video-assisted thoracoscopic surgery in primary spontaneous pneumothorax (Guangzhou)

“…Intravenous anesthesia with spontaneous breathing has been applied in VATS, as it is deemed to offer fewer side effects than anesthesia with endotracheal intubation, thus potentially enabling faster postoperative recovery. Many studies have demonstrated that SV-VATS bullectomy is safe and feasible for the treatment of PSP (9,13,31). PSP patients are often young and have good pulmonary function, stable hemodynamics, and only few comorbidities if at all, making the effects of intravenous anesthesia more predictable and stable intraoperative physiologic management is more easily maintained.…”