THORACOSCOPIC MANAGEMENT OF PRIMARY SPONTANEOUS PNEUMOTHORAX - A COMPARATIVE-STUDY

A retrospective study was performed to assess the advantages and disad vantages of a video-assisted thoracoscopic approach (VTS) to the surgi cal management of primary spontaneous pneumothorax compared with the s tandard posterolateral thoracotomy (PLT) or posterior muscle sparing ( PMS) approaches. It was possible to make comparisons between 12 VTS, n ine PLT and six PMS patients who underwent unilateral apical bullectom y/stapling with apical pleurectomy/abrasion for primary spontaneous pn eumothorax. The groups were evenly matched with regards age, sex and i ncidence of pneumothorax. The operative time for VTS was significantly greater than for PLT (P = 0.014) but not for PMS (P = 0.297) procedur es. VTS procedures resulted in significant decreases in the overall pe riod of pleural drainage compared with PLT (P = 0.031) and PMS (P < 0. 001) procedures. Patients having a VTS procedure had a median hospital stay of 3 days, significantly shorter than that associated with the o ther approaches (PLT, P < 0.001; PMS, P < 0.001). The daily in-hospita l analgesic requirements were similar for all groups. Using VTS an ide ntical operation can be performed with smaller incisions and shorter h ospital stay. Long-term recurrence rates and length of time off work w ill eventually determine whether VTS is a more economic approach to pl eurectomy.