Video-Assisted Thoracoscopic Pleurectomy in Spontaneous Pneumothorax Surgery

Abstract

OBJECTIVES:Published experiences with thoracoscopic apical or total pleurectomy for patients with a pneumothorax are limited. We aimed to evaluate the long-term results and effectiveness of pleurectomy in our patients, that vast majority of whom underwent thoracoscopic apical or total pleurectomy. MATERIAL AND METHODS:Between January 2001 and December 2010, in the Istanbul University Medical School Department of Thoracic Surgery, 67 patients, consisting of 52 patients with a primary spontaneous pneumothorax and 15 with a secondary spontaneous pneumothorax who underwent 72 processes of thoracoscopic resection of blebs or bullae and pleural symphysis, consisting of 43% total pleurectomy, 42% apical pleurectomy plus pleural abrasion, and 15% non-pleurectomy pleurodesis procedures due to prolonged air leak or recurrent spontaneous pneumothorax, were analyzed retrospectively. The applied pleural procedures were: 1. total pleurectomy 2. apical pleurectomy and pleural abrasion for the remaining parts and 3. non-pleurectomy pleurodesis procedures. The long-term outcomes of patients undergoing the three different pleural procedures were compared. RESULTS:Total pleurectomy process, apical pleurectomy and abrasion process for remaining parietal pleura, and non-pleurectomy pleurodesis procedures were performed 31, 30, and 11 times, respectively. No recurrence was observed in the total pleurectomy group, 1 recurrence was observed for the apical pleurectomy plus pleural abrasion group, and 2 recurrences were observed for the nonpleurectomy group. CONCLUSION:Video-assisted thoracoscopic pleurectomy is a safe and effective method in spontaneous pneumothorax surgery. Especially, total pleurectomy has efficient results in the prevention of recurrences.

A different approach in primary spontaneous pneumothorax surgery: Lateral pleurectomy technique and results

“…Although the current uniportal VATS procedures successfully reduce the recurrence rate, it is still known that the thoracotomy procedure has the most successful rate in preventing recurrence (4,9). However, the significant success of uniportal VATS in terms of minimal incision scar, post-operative pain advantage, drainage, LOS, and early return to routine life has made it the standard PSP surgical procedure today (10)(11)(12).…”

“…However, a substantial number of studies show that AP gives the same recurrence rates as apical pleural abrasion (7,8). Moreover, advantages such as shorter operation time, less drainage, shorter hospital stay, and less pain were reported with the apical pleural abrasion technique than the AP technique in these studies (7)(8)(9).…”

Understanding The Acute Interventions for Complicated Pleural Effusions

“…After resection, electrocautery is used to achieve homeostasis, and a 28-Fr chest tube is inserted and connected to a water seal system for drainage post-procedure [29]. One of the main indications for VATS Pleurectomy is primary spontaneous pneumothorax and recurrent spontaneous pneumothorax [30,31]. VATS permits the entire lung's observation, identifying blebs and bullae and resecting these diseased areas [32].…”