Video-assisted thoracoscopic surgery (VATS) for bilateral primary spontaneous pneumothorax

Abstract

Abstract:Objective: To review our experience of the treatment of bilateral primary spontaneous pneumothorax (PSP) by video-assisted thoracoscopic surgery (VATS). Materials and methods: Retrospective chart review was followed by an on-clinic or telephone interview. Patients were cared for by one thoracic surgeon in four medical centers or community hospitals in Northern and Central Taiwan. Thirteen patients with bilateral PSP underwent bilateral VATS simultaneously or sequentially from July 1994 to December 2005. Results: Twelve males and one female, with age ranging from 15 to 36 years (mean 23.1 years), were treated with VATS for bilateral PSP, under the indications of bilateral pneumothoracis simultaneously (n=4) or sequentially (n=9). The interval between the first and second contra-lateral VATS procedure for non-simultaneous PSP patients ranged from 7 d to 6 years. Eleven of 13 patients (84.6%) had prominent pulmonary bullae/blebs, and underwent bullae resection with mechanical or chemical pleurodesis. The mean operative time was (45.6±18.3) min (range 25~96 min) and (120.6±28.7) min (range 84~166 min) respectively for the non-simultaneous (second VATS for the recurrence of contralateral side after first VATS) and simultaneous (bilateral VATS in one operation) procedures. There was no postoperative mortality. However, prolonged air leakage (>7 d) occurred in one patient (7.7%) who recovered after conservative treatment. The mean duration of chest tube drainage was 3.1 d and the median follow up period was 3.4 years. Conclusions: VATS is a safe and effective procedure in the treatment of bilateral PSP. Bilateral VATS is only recommended for patients with simultaneously bilateral PSP, because the incidence of recurrence, even with visible bullae, was not so high in my group and in some previous literature. Bilateral VATS in a supine position should only be used in selective cases, because of possible pleural adhesion or hidden bullae on the posterior side.

Diagnosis and treatment of primary spontaneous pneumothorax

“…Primary spontaneous pneumothorax (PSP), which is defined as a pneumothorax without underlying lung disease, predominantly occurs in young, thin males. It is usually caused by ruptured pleural blebs or bullae (Abdala et al, 2001;Chen Y.J. et al, 2008).…”

“…Chemical pleurodesis by minocycline injection, which has been developed in our group (Luh et al, 1996), has been shown to be a safe and convenient procedure that can reduce the rate of recurrence after VATS in a retrospective or prospective randomized trial by colleagues (Chen et al, 2004;2006). However, we do not routinely perform this procedure because it frequently results in intense chest pain and fever, and this additional procedure is only preserved for patients with persistent air-leakage or a higher risk of recurrence, such as multiple or huge bullae (Luh et al, 2004;Luh and Tsao, 2007;Chen Y.J. et al, 2008).…”

Video-assisted thoracoscopic surgery (VATS) for the treatment of hepatic hydrothorax: report of twelve cases

“…Because talc is no longer permitted to be used at human body since 2000 in Taiwan, we used pleural electrocauterization for pleurodesis combined with postoperative minocin pleurodesis for some of our patients and can achieve equivalent results (Chen et al, 2008;Hsu et al, 2009). The cauterization was applied most densely on the diaphragmatic surface and lower parietal pleura, and also applied on upper parietal pleura, but with less dense electrocauterization spots.…”

Bulectomia bilateral por cirurgia torácica vídeo-assistida uniportal combinada com acesso contralateral ao mediastino anterior

“…( 5 , 6 ) According to the literature, most lung bullae are bilateral, resulting in bilateral pneumothorax. ( 8 ) Therefore, it is worth discussing how to perform one-stage bullectomy for the treatment of bilateral SP. One-stage sequential bilateral VATS bullectomy has been considered the best choice.…”