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Ann Thorac Surg 1995;60:931-933
© 1995 The Society of Thoracic Surgeons

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Original Articles: General Thoracic

Video-Assisted Thoracic Surgery: Primary Therapy for Spontaneous Pneumothorax?

Section of Thoracic Surgery, University of Tennessee Center for the Health Sciences, Memphis, Tennessee, and Department of Thoracic Surgery, Naval Medical Center San Diego, San Diego, California

Background. This study assessed the role of video-assisted thoracic surgery (VATS) in current therapy for spontaneous pneumothorax.

Methods. We compared a retrospective series of 89 patients treated conventionally with a consecutive group of 30 patients undergoing VATS pleural abrasion. The 89 earlier patients were predominantly male (81%). Treatment groups included observation/aspiration (7 or 17%), tube thoracostomy (32 or 36%), multiple tubes (7 or 9%), and thoracotomy (43 or 48%). Of the 30 patients treated with VATS, 18 (66%) were male. Primary indications for operation were recurrent pneumothorax (17) and persistent air leak (9).

Results. Hospital lengths of stay (LOS) for the earlier group were 5 days for simple tube and 7 days for primary thoracotomy; LOS for initial intervention followed by thoracotomy exceeded 15 days in all subgroups. The average LOS in the VATS group was 13 days; 6 patients treated with primary VATS (no chest tube) had a mean LOS of 6.5 days. Complications included 3 (10%) prolonged air leaks (more than 7 days) and 2 (7%) early recurrences.

Conclusions. We do not recommend VATS as primary therapy for spontaneous pneumothorax; tube thoracostomy remains the treatment of choice. However, we strongly support surgical intervention early (3 days) in patients with a persistent air leak, and as primary therapy in a nonurgent situation if standard indications exist. This study shows no advantage of VATS over conventional thoracotomy in hospital stay or complication rate.

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Discussion
Ann. Thorac. Surg. 1995 60: 934-935. [Extract] [Full Text]

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