Current opinion and comparison of surgical procedures for the treatment of primary spontaneous pneumothorax

ABSTRACT

Introduction

Although three-port video-assisted thoracoscopic surgery (VATS) is the standard radical treatment for primary spontaneous pneumothorax (PSP), several issues need to be addressed as the postoperative recurrence rate remains relatively high. Although bullectomy is effective in preventing the postoperative recurrence of PSP, recurrent pneumothorax often occurs, requiring additional methods such as pleural covering with absorbable mesh sheets, surgical chemical pleurodesis, pleural abrasion, or pleurectomy. In addition, minimally invasive approaches that exceed three-port VATS are required according to the social demand. These approaches, such as uniportal VATS, reduced port surgery, and needlescopic surgery, have cosmetic merits, lower postoperative pain, and similar surgical results as three-port VATS.

Areas covered

We focused on conventional and novel treatments for PSP in this article.

Expert opinion

Effective methods that prevent postoperative recurrence and minimally invasive approaches will become popular in the near future.

KEYWORDS:

• Primary spontaneous pneumothorax
• minimally invasive
• covering
• pleurodesis
• pleurectomy
• pleural abrasion
• VATS
• uniport
• reduced port surgery
• needlescopic

Funding

This paper was not funded.

Article highlights

• Surgical procedures are considered after recurrence with conservative treatment for primary spontaneous pneumothorax (PSP). Other causes such as prolonged air leakage, first contralateral pneumothorax, synchronous pneumothorax, hemopneumothorax, and professions at risk are also indications for surgery.

• Three-port video-assisted thoracoscopic surgery (VATS) has been the standard approach for the last 30 years, replacing axillary thoracotomy.

• Although bullectomy is effective in preventing postoperative recurrence, postoperative recurrence often occurs.

• Various techniques or methods, including pleural covering by absorbable mesh sheets, surgical chemical pleurodesis, pleural abrasion, and pleurectomy, have been performed to reduce the postoperative recurrence rate.

• Although three-port VATS is less invasive than axillary thoracotomy, minimally invasive approaches are required, as in the field of lung cancer surgery.

• The three-port VATS is a low invasive approach, while uniportal VATS, reduced port surgery (RPS), and needlescopic surgery are minimally invasive.

• Generally, uniportal VATS has cosmetic merits and lower postoperative pain and paresthesia rates. There are transthoracic approaches that use the conventional method, the chest wall pulley method, and the subxiphoid approach. For RPS, the transareolar approach has the most invisible incision.

• In the future, more effective methods for preventing postoperative recurrence will be developed, and minimally invasive approaches will become popular.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.