Video-assisted thoracic surgery (VATS) for spontaneous pneumothorax: Outcome of 189 cases

Introduction: The crucial role of video-assisted thoracic surgery (VATS) in the treatment of spontaneous pneumothorax is well acknowledged today. Experiences of such patients undergoing VATS by one surgeon were reported to evaluate the feasibility of such surgical approach. Methods: From January 1, 1996 to January 1, 2002, out of 1,034 VATS procedures performed by one surgeon, 189 patients (18.3%) underwent VATS treatment for first onset or recurrent primary pneumothorax (n = 134), secondary pneumothorax (n = 49), and re-do VATS (n = 6) pneumothorax. The surgical approaches for these patients were through scope and working ports, and 6 (3.2%) of them the procedure were converted into open thoracotomy due to pleural adhesion or other causes. Bullae over apex or other sites of lung were identified in 164(86.8%) patients. Mechanical pleurodesis with gauze abrasion or electrocoagulation was performed on all patients, and chemical pleurodesis with minocin intrapleural injection or talc powder was performed on 144(76.2%) of them. The bullae was excised with endo-GIA(n = 122), endoloop (n = 23),electro-ablation(n = 9),suturing through open or endoscopic port(n = 10). The operation time ranged from 23 to 3 5 5 (42.4 +/- 12.6)minutes. Results: The mean postoperative chest tube duration and hospital stay were 2.4 +/- 1.3 (1 to 26) and 4.3 +/- 1.2 (1 to 35) days. Complication occurred in 15 cases (7.9%), including 9 patients with persistent air-leakage (>10 days), 3 patients with bleeding, 6 patients with pneumonia or ventilator dependent, and 3 patients with wound infection. Recurrence occurred in 6 (3.2%) patients. Two patients (1.1%) died from complications related to underlying disease (severe emphysema) postoperatively. Conclusions: VATS treatment is the best choice for the treatment of recurrent primary spontaneous pneumothorax. It also can be used for patients with first onset spontaneous or traumatic pneumothorax with persistent air leakage, or secondary pneumothorax. We preferred bullectomy with endo-GIA because it is safer (low recurrence rate) and the specimen can reveal the possible underlying disease.