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Ann Thorac Surg 1996;62:1887-1888
© 1996 The Society of Thoracic Surgeons

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Correspondence

Transaxillary Minithoracotomy for Spontaneous Pneumothorax

Division of Cardiothoracic Surgery The Chinese University of Hong Kong Prince of Wales Hospital Shatin, Nt Hong Kong

To the Editor:

I read with interest the comparative study by Kim and associates [1] on transaxillary minithoracotomy versus video-assisted thoracic surgery for spontaneous pneumothorax. They reported no statistical differences in operating time, analgesic requirement, chest drainage duration, and procedure failures (recurrences) between the two modalities and hence concluded that there was no advantage for video-assisted thoracic surgery. However, in their video-assisted thoracic surgery group, the operating time (91.2 +/- 36.8 minutes) and chest drainage duration (5.0 +/- 4.0 days) are substantially greater and there were more recurrences (4 of 36) on intermediate follow-up than in most reports of this technique in the literature, including ours [2].

There are two further points of note. First, I agree with them that the cost of the consumables is a major concern in Asia. We reported our technique of thoracoscopic suturing (instead of using endoscopic staplers) for apical bullae with good results [3]. Even if one chooses to approach with transaxillary minithoracotomy, video assistance would greatly facilitate exposure and allow a more complete pleurodesis. Transaxillary minithoracotomy and video assistance are not mutually exclusive. Second, flexing the operating table at the level of the minithoracotomy opens up the intercostal spaces and often renders rib spreading unnecessary [4]. We believe that this maneuver is important in minimizing postoperative pain, both short-term and long-term.

References

1. Kim KH, Kim HK, Han JY, Kim JT, Won YS, Choi SS. Transaxillary minithoracotomy versus video-assisted thoracic surgery for spontaneous pneumothorax. Ann Thorac Surg 1996;61:1510–2.
2. Yim APC, Liu HP. Complications and failures of video-assisted thoracic surgery: experience from two centers in Asia. Ann Thorac Surg 1996;61:538–41.
3. Yim APC. Video assisted thoracoscopic suturing of apical bullae-an alternative to staple resection in the management of primary spontaneous pneumothorax. Surg Endosc 1995;9:1013–6.
4. Yim APC. Minimizing chest wall trauma in video assisted thoracic surgery. J Thorac Cardiovasc Surg 1995;109:1255–6.

Reply

Department of Thoracic Cardiovascular Surgery Inha University Hospital 7-206 Shinheungdong 3-ka Choonggu Inchon 400-103 Republic of Korea

To the Editor:

I thank Dr Yim for his comment on our article. As he pointed out, the operating time and chest tube drainage duration in the video-assisted thoracic surgery group were slightly greater than those of the transaxillary minithoracotomy group, and the recurrence rate in the video-assisted thoracic surgery group was somewhat greater than that of the transaxillary minithoracotomy group. I think the operating time and timing of chest tube removal are dependent on the surgeon's prudence in addition to the medical reasons. The reason for the longer operating time and chest tube indwelling period is my colleague and I are cautious doing the operation and removal of the tube. Regarding the recurrence, there was no specific reason. However, the differences between two groups were small and not statistically significant. I think that it means there were no differences in the surgical outcomes between the two groups.

Minithoracotomy with video assistance is very helpful to search the bullae and perform bullectomy in patients with spontaneous pneumothorax. Currently we are using video assistance in some minithoracotomies.

We have had no experience with thoracoscopic suturing for apical bullectomy. I think the technique would be very good for reducing use of endoscopic staplers. Flexing the operating table at the level of the minithoracotomy is an excellent idea for opening up the intercostal space on the middle part of the trunk, but I think it is difficult to open up the second or third intercostal space for transaxillary thoracotomy because those spaces are located on the axilla.

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Anthony P. C. Yim Kwang Ho Kim Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Yim, A. P. C. Articles by Kim, K. H. Search for Related Content PubMed Articles by Yim, A. P. C. Articles by Kim, K. H.