Videothoracoscopic surgical approach for spontaneous pneumothorax: review of the pertinent literature

Abstract

Spontaneous pneumothorax is usually caused by the rupture of subpleural blebs/bullae in the underlying lung and is one of the most common elective applications of video-assisted thoracoscopic surgery (VATS). VATS has been used as an alternative to thoracotomy in the treatment of spontaneous pneumothorax. Recurrent pneumothorax and persistent air leakage are quite often indications for spontaneous pneumothorax, and bilateral spontaneous pneumothorax is also considered to be an indication for surgical intervention. The goals of surgical intervention are to eliminate intrapleural air collection and prevent recurrence. Diverse procedures have been reported in the surgical treatment for spontaneous pneumothorax. We review the literature regarding the VATS approach for spontaneous pneumothorax.

Primary Spontaneous Pneumothorax in Pediatric Patients: Our 7-Year Experience

“…Spontaneous pneumothorax occurs as a disruption of visceral pleura, with an escape of air into the pleural space with secondary lung collapse. [15][16][17] Pneumothorax is divided into ''small,'' ''moderate,'' or ''complete,'' depending on the presence of a visible rim between the lung and chest wall. In the guidance for treatment of spontaneous pneumothorax, spontaneous pneumothoracies were classified into three groups (18): ''Small''-small rim of the air around the lung <2 cm, chest tube not necessary ''Moderate''-lung collapsed halfway toward the heart border ''Complete''-airless lung, separate from the diaphragm …”

Titrated Sedation with Propofol for Medical Thoracoscopy: A Feasibility and Safety Study

“…To date, VATS is always performed under general anesthetic with endotracheal intubation and selective one-lung ventilation by surgical and anesthesia teams (thoracic surgeon, scrub nurse, anesthesiologist and residents or assistants), in a fully equipped operating theater. In contrast, MT is routinely performed by chest physicians under light sedation (or so-called ‘conscious sedation’) in spontaneously breathing patients in facilities outside the costly environment of operating rooms [5,6,7,8]. Among nonanesthesiologists, midazolam remains the preferred sedative drug, although gastrointestinal endoscopists have gained much experience with the administration of propofol [9,10,11,12,13].…”

Spontaneous Pneumothorax Recurrence and Surgery

“…The recurrence rate for the PSP ranges from 7.6 to 52 % and for the SSP from 22.7 to 47 %. Most of them take place between 6 months and 2 years after the first episode [2,[4][5][6][7][8]. Most studies reveal the recurrence rates after conservative treatment, aspiration, or tube thoracostomy.…”

“…Chest tube drainage with 28-Fr chest tube was performed through the anterior-axillary line of the fourth or fifth intercostal space under local anesthesia to all of the patients for the first episode of pneumothorax because of varying of pneumothorax rates from 20 % to total. According to the statistical and perceived risk of recurrence, accepted indications for operative intervention are as follows: second ipsilateral pneumothorax, first contralateral pneumothorax, bilateral spontaneous pneumothorax, persistent air leak (>7 days of tube drainage; air leakage, or failure to completely re-expand), spontaneous hemothorax, and professions at risk (e.g., pilots, divers) [4]. Chest computed tomography (CT) was applied to a patient at expansion period to know the cause of pneumothorax ( Fig.…”