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Ann Thorac Surg 1996;61:1645
© 1996 The Society of Thoracic Surgeons

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Invited Commentary

Invited Commentary

Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, 800 N Rutledge, PO Box 19230, Springfield, IL 62794-1312

See also page 1641.

Many of the conclusions of this article support the preponderance of evidence with respect to the use of video-assisted thoracic surgery (VATS) for primary spontaneous pneumothorax. There appears to be a learning curve for this procedure, which results in some prolonged air leaks and some early recurrences. The most likely explanations are missed blebs/bullae and technical problems in the use of the endoscopic stapler. In some instances the stapler is applied too close to the bulla/bleb and in some cases there is excessive tension placed on the lung (due to improper angles) that results in unrecognized lacerations near the stapler line. Inadequate pleural abrasion may also be considered a learning curve issue.

Bertrand and associates concluded that VATS resulted in a shorter hospital stay and a quicker return to activity. Although I believe this to be true, the evidence is retrospective and may be influenced by bias in the surgeons' expectations. Informing patients that they will be in the hospital for a shorter period of time and return to work sooner surely has some impact. Similarly the findings of less acute pain with VATS but similar chronic pain supports previous studies; however, pain was not rigidly quantitated by visual analogue scales or standardized pain questionnaires.

Video-assisted bleb/bulla resection has become an accepted alternative for treating patients with primary spontaneous pneumothorax as suggested by Bertrand and associates. There is a learning curve for this procedure. I would recommend from my experience that if a careful evaluation of the lung does not result in the finding of the offending pathology, a VATS apical pleurectomy should be performed or the procedure should be converted to "open" as it is in this group of patients that recurrence often results. With careful attention to detail and experience with VATS, the incidence of recurrent pneumothoraces should mirror that of open techniques.

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Ann. Thorac. Surg. 1996 61: 1641-1645. [Abstract] [Full Text]

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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): Stephen R. Hazelrigg Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hazelrigg, S. R. Search for Related Content PubMed Articles by Hazelrigg, S. R. Related Collections Related Article