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

Abstract

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.

A modified two-port thoracoscopic technique versus axillary minithoracotomy for the treatment of recurrent spontaneous pneumothorax: a prospective randomized study

“…Significant reduction in the volume of the upper lobe may be responsible for apical pleural space formation and failure of pleurodesis in these patients. A limitation of the current study was the relatively short follow-up period (up to 53 months) considering that most recurrences occur within the first 12 months after surgical pleurodesis [7,8,[18][19][20].…”

Preventing recurrence of spontaneous pneumothorax after thoracoscopic surgery: A review of recent results

“…7,8,22 The initially high incidence of postoperative SP recurrence 2,5,6 was attributed to such causal factors as an oversight of bulla, new bulla formation from pulmonary pleura damaged during forceps manipulation, and most commonly, new bulla formation near the staple lines. 6 It remains a matter of speculation as to why a bullectomy with a stapler, which has not been an issue in thoracotomy, is a problem in thoracoscopic surgery, and why new bullae form near the staple line.…”

“…The results for each additional surgical procedure are summarized in Table 4. 1,2,6,7,[12][13][14][15][16][17][18] Suturing/Loop Ligation Some reports advocated thoracoscopic suturing 4,19 or loop ligation 20,21 as opposed to stapled bullectomy, based on the rates of postoperative SP recurrence and cost. Suturing was superior to stapled bullectomy with respect to cost and a low recurrence rate.…”

“…1,3,7 Although some investigators have recommended and practiced extensive pleural excision, 22 this procedure is not popular because of its invasiveness. Partial excision of the pulmonary apical portion of the parietal pleura results in the lung adhering to the chest wall; however, the possible need for second thoracotomy and postoperative complications such as bleeding 22 must be considered carefully when deciding on its indications and related hemostatic treatment.…”

“…[1][2][3][4] However, after an unexpectedly high rate of postoperative SP recurrence after thoracoscopic surgery was verifi ed, 2,5,6 a series of reports advocated a return to thoracotomy as a radical operative method for SP with a low recurrence rate. [1][2][3]5,[7][8][9][10]11 Subsequently, other thoracoscopic surgical procedures, in addition to stapled bullectomy only, were developed and the postoperative recurrence rate gradually declined. 6,[12][13][14][15][16] Now, the postoperative recurrence rate of SP is equal to or lower than that after thoracotomy.…”