Ann Thorac Surg 2000;70:417
© 2000 The Society of Thoracic Surgeons
Invited commentary
Invited commentary
Jean Deslauriers, MD
Centre de pneumologie de l’Hôpital Laval, 2725, chemin Sainte-Foy, Sainte-Foy QCG1V 4G5, Canada
The study by Lang-Lazdunski and associates presents 12 patients who underwent single-stage bilateral videothoracoscopic operations for the management of primary spontaneous pneumothoraces. Although no one can deny the usefulness of VATS procedures in the management of this disease, one should note that in 9 of these 12 patients the indication for surgery (based on job restrictions) was questionable, as only 10% to 15% of these individuals would be expected to present with contralateral pneumothoraces and therefore possibly require surgery at a later time. Though it is clear that videothoracoscopic procedures are minimally invasive, they can still lead to complications; obviously this would be disastrous in patients in whom the indication for surgery was at best marginal.
It is also of interest to note that all of these patients needed preoperative computed tomographic scan and postoperative epidural analgesia. In addition, the mean average drainage time was 5 days and the mean hospital stay was 7.7 days if one excludes the patient who required reoperation. All of these parameters are substantially different from what is seen after unilateral procedures (VATS or transaxillary) and they certainly increase the complexity of treatment. As only 1 of 9 patients would be expected to have a contralateral pneumothorax, the overall costs of performing bilateral surgery in all patients would also appear to be higher. Obviously, as suggested by the authors, a prospective study could answer some questions, but it is doubtful that such a study will ever be completed mainly because of the small number of cases available for study.
Related Article
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Primary spontaneous pneumothorax: one-stage treatment by bilateral videothoracoscopy
- Loïc Lang-Lazdunski, Xavier de Kerangal, François Pons, and René Jancovici
Ann. Thorac. Surg. 2000 70: 412-417.
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