Does a thoracoscopic approach for surgical treatment of spontaneous pneumothorax represent progress?

• Published in: European journal of cardio-thoracic surgery 1997-01, Vol.11 (1), p.27-31
• Main Authors: DUMONT, P, DIEMONT, F, MASSARD, G, TOUMIEUX, B, WIHLM, J. M, MORAND, G
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Endoscopes; Humans; Lung - pathology; Male; Medical sciences; Middle Aged; Pneumology; Pneumothorax - pathology; Pneumothorax - surgery; Postoperative Complications - etiology; Postoperative Complications - surgery; Recurrence; Reoperation; Respiratory system : syndromes and miscellaneous diseases; Retrospective Studies; Thoracoscopes; Thoracotomy - instrumentation; Treatment Outcome; Video Recording - instrumentation
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(96)01021-4

OBJECTIVE: Surgical management is indicated in recurrent forms ofpneumothorax and for failure of tube drainage. We have for several yearsperformed pleurodesis and apical blebs stapling by axillary thoracotomy.Thoracoscopy has been a well established procedure for 70 years andrecently further developed as the result of current technological progress.For 10 years thoracoscopy has been developed as an alternative tothoracotomy in several indications. Spontaneous pneumothorax is ideallysuitable for thoracoscopic management. The aim of this retrospective studyis to evaluate this new approach. METHODS: We compare our results ofaxillary thoracotomy management of spontaneous pneumothorax in 237 patients(group 1) with those of thoracoscopic management in 101 patients (group 2).Sex distribution, average age, indications and stapling of apical blebswere comparable in both groups. RESULTS: Etiologies were comparable in bothgroups. The average operation time was 71 min in group 1 and 57 min ingroup 2. The average duration of chest tube placement was 8 days in group 1and 6.5 days in group 2. The mean hospital stay was 14 days in group 1 and9.5 days in group 2. The overall morbidity was 16 and 11% in groups 1 and2, respectively. The most frequent complication was early or late failureof pleurodesis which required second drainage or a subsequent operation.Late failure occurred more frequently after thoracoscopy (3 vs. 0.4%) butthere was no statistically significant difference between the two groups.CONCLUSIONS: Thoracoscopic management of spontaneous pneumothorax is a safeprocedure. Moreover, it offers the benefits of a shorter hospital stay andless postoperative pain.