VIDEO-ASSISTED THORACOSCOPIC TREATMENT OF SPONTANEOUS PNEUMOTHORAX - TECHNIQUE AND RESULTS OF 100 CASES

Objective: This article describes the technique and results for an ini tial series of 100 pneumothoraces treated by video-assisted thoracosco py. Methods: From May 1991 to November 1994, 97 patients (78 male and 19 female patients) aged 37.2 +/- 17 years (range 14 to 92 years) unde rwent video-assisted thoracoscopy for treatment of spontaneous pneumot horax (primary in 75 patients, secondary in 22 patients). Results: The procedure was unilateral in 94 patients and bilateral in three patien ts (total 100 cases), Pleural bullae were resected with an endoscopic linear stapler; a lung biopsy was performed in the absence of any iden tifiable lesion, Pleurodesis was achieved by electrocoagulation of the pleura (n = 3), ''patch'' pleurectomy (n = 3), subtotal pleurectomy ( n = 20), or pleural abrasion (n = 74), including conversion to standar d thoracotomy in five, One of these five patients had primary pneumoth orax and four had secondary pneumothorax. There were no postoperative deaths. A complication developed in 10 patients: five patients with a primary pneumothorax (6.6%) and five with a secondary pneumothorax (27 .7%). The mean postoperative hospital stay was 8.25 +/- 3.2 days, Mean follow-up is 30 months (range 7 to 49 months). Pneumothorax recurred in 3% of patients, all of whom were operated on at the start of our ex perience, Three percent of the patients had chronic postoperative ches t pain. Conclusions: Video-assisted thoracoscopy is a valid alternativ e to open thoracotomy for the treatment of spontaneous primary pneumot horax. Its role for the management of secondary pneumothorax remains t o be defined. In the long term, the efficacy of video-assisted thoraco scopic pleurodesis and surgeon experience should yield the same result s as standard operative therapy.