Video‐Assisted Thoracic Surgery in Spontaneous Pneumothorax

Abstract

The proven safety and efficacy of minimal access video-assisted thoracic surgery has changed the way that spontaneous pneumothorax is managed. This review presents some of the experiences of the decade, discusses the controversies and reviews the current video-assisted thoracic surgical management of spontaneous pneumothorax.

Video-assisted thoracic surgery for primary spontaneous hemopneumothorax

“…When compared with the conventional thoracotomy operation, VATS is known to have quicker access time, less access trauma, reduced postoperative pain, and faster recovery with shorter postoperative hospital stay. Thus, VATS is increasingly considered as the better alternative to the open approach [2]. Results from our retrospective study support the practice of VATS in SHP with potential advantages of shorter postoperative stay and less complications to the patient compared with open surgery.…”

“…The young age group of SHP patients places them in the low anesthetic risk category, and the benefit of performing surgery while patients are stable and not when they are decompensating hemodynamically should not be underestimated. In particular, VATS offers the added advantages of better view of the pleural cavity, identifying and stopping the bleeding directly, evacuation of clotted blood from pleural cavity, sealing the area of air leak with endoscopic stapler and mechanical pleurodesis, as well as placement of the drainage tube under direct thoracoscopic vision all performed under minimal access trauma [2]. When compared with the conventional thoracotomy operation, VATS is known to have quicker access time, less access trauma, reduced postoperative pain, and faster recovery with shorter postoperative hospital stay.…”

“…Tube thoracostomy, aspiration of hemothorax, thoracotomy, and decortication after the initial period of rest has all been used as treatment of SHP. Video-assisted thoracic surgery (VATS) has been used successfully in the management of SP with added advantages of less tissue trauma and less postoperative pain when compared with traditional thoracotomy approach [2,3]. More recently, VATS has been increasingly being used for the management of SHP with favorable results [4].…”

Spontaneous hemopneumothorax: Our experience with surgical management

“…There are other advantages of using VATS in the surgical management of SHP, namely excellent visualization of the pleural cavity, identification and treatment of the bleeding source, evacuation of blood and retained clots, resection of blebs or bullae (if present), and performing pleurodesis as well as placement of chest tubes under direct vision with minimal trauma. 8 The results of our retrospective study support the practice of early surgery which can be performed with minimal morbidity and mortality.…”

Factors related to recurrence of spontaneous pneumothorax

“…However, the recurrence rate with chemical pleurodesis is significantly greater than seen with medical pleurodesis using talc insufflation, 31,32 video assisted thoracic surgery with stapling of blebs coupled with a procedure to produce a pleurodesis 1 or thoracotomy with bullectomy, pleurodesis or pleurectomy 33 . In general, the more invasive the treatment, the lower the recurrence rate 34–36 . The procedure used in a given institution will depend in large part upon the resources available.…”