Thoracoscopic management of primary spontaneous pneumothorax – a comparative study

Abstract

A retrospective study was performed to assess the advantages and disadvantages of a video-assisted thoracoscopic approach (VTS) to the surgical management of primary spontaneous pneumothorax compared with the standard posterolateral thoracotomy (PLT) or posterior muscle sparing (PMS) approaches. It was possible to make comparisons between 12 VTS, nine PLT and six PMS patients who underwent unilateral apical bullectomy/stapling with apical pleurectomy/abrasion for primary spontaneous pneumothorax. The groups were evenly matched with regards age, sex and incidence of pneumothorax. The operative time for VTS was significantly greater than for PLT (P = 0.014) but not for PMS (P = 0.297) procedures. VTS procedures resulted in significant decreases in the overall period of pleural drainage compared with PLT (P = 0.031) and PMS (P < 0.001) procedures. Patients having a VTS procedure had a median hospital stay of 3 days, significantly shorter than that associated with the other approaches (PLT, P < 0.001; PMS, P < 0.001). The daily in-hospital analgesic requirements were similar for all groups. Using VTS an identical operation can be performed with smaller incisions and shorter hospital stay. Long-term recurrence rates and length of time off work will eventually determine whether VTS is a more economic approach to pleurectomy.

Key Words:

• pneumothorax
• thoracoscopy
• thoracotomy