Video-assisted thoracic surgery: Primary therapy for spontaneous pneumothorax?

Cole, Francis H.; Khandekar, Alim; Maxwell, J. Matthew; Pate, James W.; Walker, W. Allan

doi:10.1016/0003-4975(95)00598-f

Cited by 65 publications

(19 citation statements)

References 12 publications

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“…Published data [1,3] concerning treatment of recurrent SP by thoracotomy showed a recurrence rate of less than 1%, while Kim et al [8] have shown no advantages of VATS over transaxillary mini thoracotomy. Other studies expressed their doubts about the advantage of VATS over thoracotomy [7,8,14,15]. Some studies comparing VATS and thoracotomy are summarized in table 2.…”

Section: Discussionmentioning

confidence: 99%

Video-Assisted Thoracoscopy versus Thoracotomy for Primary Spontaneous Pneumothorax: A Randomized Controlled Trial

Ayed

Al-Din

2000

Med Princ Pract

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Objective: Video-assisted thoracic surgery has been evaluated to replace thoracotomy for recurrent or persistent spontaneous pneumothorax. This study aimed to compare the clinical results and long-term follow-up of both procedures in treating primary spontaneous pneumothorax. Methods: In a prospective comparison, all 60 patients aged 14–57 years with recurrent or persistent primary spontaneous pneumothorax seen at the Chest Diseases Hospital in Kuwait were randomly allocated to treatment by video-assisted surgery or thoracotomy. Subsequently various factors were analysed and compared in both groups, and the follow-up of both procedures was 3 years. Results: The mean and standard deviation (SD) operating time was longer in the thoracotomy group (95.3 ± 16.4 min) than in those undergoing video-assisted thoracoscopy (77.5 ± 13.7 min; p < 0.0001). The mean ± SD amount of analgesics (Demerol) used in the first 12 h postoperatively was 67.16 ± 27.1 mg in the video-assisted thoracoscopy group and 148.3 ± 24.5 mg in the thoracotomy group (p < 0.0001). The mean 24-hour chest tube drainage was less in the video-assisted thoracoscopy group than in the thoracotomy group (82 vs. 347.1 ml; p < 0.0001). The mean duration of intercostal chest tube was 4.1 days in the thoracoscopy group and 5 days in the thoracotomy group (p = 0.18). The length of hospital stay was shorter in the thoracoscopy group than in the thoracotomy group (6.5 vs. 10.7 days; p < 0.0001). After a follow-up of 3 years, the number of recurrences was 3 in the thoracoscopy group and none in the thoracotomy group. Conclusion: Video-assisted thoracoscopy has many clinical advantages over thoracotomy for recurrent or persistent primary spontaneous pneumothorax; but it results in a higher recurrence rate. The future role of video-assisted thoracoscopic surgery in this disease remains to be determined by a larger study.

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Section: Discussionmentioning

confidence: 99%

Video-Assisted Thoracoscopy versus Thoracotomy for Primary Spontaneous Pneumothorax: A Randomized Controlled Trial

Ayed

Al-Din

2000

Med Princ Pract

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“…In these comparisons, the duration of drainage was generally shorter in the VATS group [107,121,134,135] or the same [136]; the length of hospital or post-operative stay was also shorter [107,121,134,135,137,138] or the same [136,139]; the operating time was shorter for VATS [121,135], the same for both procedures [136,137], or longer for VATS than for thoracotomy [138]; patients who underwent VATS required less narcotic analgesics than those who underwent thoracotomy [107,134,137]; postoperative complication rates were lower [134] or higher [137] in the VATS group, or the same in both groups [121]; the recurrence rate was about the same, but there seemed to be more patients with recurrences among those who underwent VATS [121,134,135,138]; the amount of operative bleeding was smaller in the VATS group [121]; patients in the VATS group returned to work earlier [107,137]; and, finally, VATS was cheaper than thoracotomy [135]. It has been reported that some of these advantages of VATS, such as the shorter duration of drainage and hospitalisation, and earlier return to work, are only valid for patients with PSP [107].…”

Section: Surgical Approaches To Both Lungsmentioning

confidence: 99%

Management of spontaneous pneumothorax: state of the art

Jm¹,

Rami–Porta²,

Noppen³

et al. 2006

European Respiratory Journal

191

141

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Spontaneous pneumothorax remains a significant health problem. However, with time, there have been improvements in pathogenesis, diagnostic procedures and both medical and surgical approaches to treatment.Owing to better imaging techniques, it is now clear that there is almost no normal visceral pleura in the case of spontaneous pneumothorax, and that blebs and bullae are not always the cause of pneumothorax. In first episodes of primary spontaneous pneumothorax, observation and simple aspiration are established first-line therapies, as proven by randomised controlled trials. Aspiration should be better promoted in daily medical practice. In the case of recurrent or persistent pneumothorax, simple talc poudrage under thoracoscopy has been shown to be safe, cost-effective and no more painful than a conservative treatment using a chest tube. There are also new experimental data showing that talc poudrage, as used in Europe, does not lead to serious side-effects and is currently the best available pleural sclerosing agent.Alternatively, surgical techniques have considerably improved, and are now less invasive, especially due to the development of video-assisted thoracoscopic surgery. Studies suggest that video-assisted thoracoscopic surgery may be more cost-effective than chest tube drainage in spontaneous pneumothorax requiring chest tube drainage, although it is more expensive than simple thoracoscopy and requires general anaesthesia, double-lumen tube intubation and ventilation.Recommendations are made regarding the treatment of pneumothorax. In secondary or complicated primary pneumothorax, i.e. recurrent or persistent pneumothorax, some diffuse treatment of the visceral pleura should be offered, either by talc poudrage under thoracoscopy or by video-assisted thoracoscopic surgery. Moreover, all of these new techniques should be better standardised to permit comparison in randomised controlled studies.

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“…The inital clinical reports on video-assisted thoracoscopic surgery lobe ctomy, published from 1993 onward, were either preliminary or involved a small number of patients, which indicated the feasibility and safety of VATS lobectomy (2-6). Since then, VATS has become an attractive surgical procedure for benign diseases, due to its low invasiveness (7,8). As the experience with VATS for benign diseases increased, VATS was gradually adopted for the treatment of lung cancer.…”

Section: Introductionmentioning

confidence: 99%

Video-assisted thoracoscopic surgery versus open lobectomy for stage I lung cancer: A meta-analysis of long-term outcomes

Liu

2012

Experimental and Therapeutic Medicine

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Abstract. The present study aimed to evaluate the evidence comparing video-assisted thoracoscopic surgery (VATS) and open lobectomy for the treatment of stage I lung cancer using meta-analytical techniques. A literature search was undertaken until July 2011 to identify comparative studies evaluating survival rates, recurrence rates and complications. Pooled odds ratios (OR) and 95% confidence intervals (95% CI) were calculated with either the fixed-or random-effects model. These studies included a total of 1, IntroductionLung cancer is the most common malignant tumor in the world. With the improvement in diagnostic technology, more and more stage I lung cancer is identified. Video-assisted thoracoscopic surgery (VATS) was first reported by Levi et al in 1990 (1). The inital clinical reports on video-assisted thoracoscopic surgery lobe ctomy, published from 1993 onward, were either preliminary or involved a small number of patients, which indicated the feasibility and safety of VATS lobectomy (2-6). Since then, VATS has become an attractive surgical procedure for benign diseases, due to its low invasiveness (7,8). As the experience with VATS for benign diseases increased, VATS was gradually adopted for the treatment of lung cancer. Thereafter, VATS lobectomy for elderly patients and series involving a larger number of patients were reported (9-14). VATS lobectomy is now accepted, if not universally, at least as an alternative surgical option for early-stage lung cancer.The advantages of VATS lobectomy, which include less pain and better pulmonary function in the early postoperative period, have been previously reported. However, there are various controversies regarding the prognosis of VATS vs. open lobectomy for stage I lung cancer. Immune system function in the early postoperative period was found to be better preserved in patients who underwent VATS lobectomy. Curability after VATS lobectomy was also reported to be similar to the generally accepted curability rate after open lobectomy. Several investigators reported that the survival rate after VATS lobectomy was similar to that after open lobectomy. Sawada et al (15), Sugiura et al (16), Tashima et al (17) and Flores et al (18) reported that there was no statistically significant difference in survival between the VATS and open lobectomy in early-stage lung cancer. However, this meta-analysis showed that VATS had significantly better survival rates in terms of overall survival at 5 years. Materials and methodsStudy selection. Electronic searches were performed of the MEDLINE, Cochrane Controlled Trial Register (CENTRAL) and EMBASE databases until July 2011. The following Mesh search headings were used: (VATS, video-assisted thoracoscopic or video-assisted thoracoscopic surgery), (open or conventional or standard lobectomy), (lung cancer or lung carcinoma), (randomized controlled trials) and (comparative study) in English (Fig. 1).Data extraction and quality assessment. Data were extracted by three independent observers using standardized forms. The rec...

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Video-assisted thoracic surgery: Primary therapy for spontaneous pneumothorax?

Cited by 65 publications

References 12 publications

Video-Assisted Thoracoscopy versus Thoracotomy for Primary Spontaneous Pneumothorax: A Randomized Controlled Trial

Video-Assisted Thoracoscopy versus Thoracotomy for Primary Spontaneous Pneumothorax: A Randomized Controlled Trial

Management of spontaneous pneumothorax: state of the art

Video-assisted thoracoscopic surgery versus open lobectomy for stage I lung cancer: A meta-analysis of long-term outcomes

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