REDUCED INFLAMMATORY RESPONSE IN MINIMAL INVASIVE SURGERY OF PNEUMOTHORAX

Objective: To elucidate whether thoracoscopy for surgical therapy of p neumothorax leads to a reduction of inflammatory responses in comparis on with standard thoracotomy. Design: A prospective randomized study. Patients: Eleven patients (9 men and 2 women; median age, 28 years; ra nge, 21-44 years) were treated by thoracotomy; 10 patients (9 men and 1 woman; median age, 26 years; range, 21-28 years) were managed thorac oscopically. The plasma concentrations of the following were determine d: polymorphonuclear granulocyte elastase and C-reactive protein as in flammatory parameters and prostanoids (prostacyclin, thromboxane A(2), prostaglandin F-2 alpha, prostaglandin M, and prostaglandin E(2)) as vasoactive parameters. Blood sampling was performed perioperatively an d on day 3 after surgery. Results: The thoracoscopy group revealed a s horter hospital stay (5 vs 7 days; P<.04) and a significantly reduced need for intravenous pain medication within 48 hours (1 vs 3 requireme nts; P<.01) vs the thoracotomy group. The release of inflammatory (C-r eactive protein, P<.01) and vasoactive (prostacyclin and thromboxane A (2), P<.01) mediators was less during thoracoscopy compared with stand ard thoracotomy. Conclusions: The thoracoscopic procedure is less inva sive when performing wedge resection of apical blebs. With intracavita ry management being equivalent to the conventional technique, the curt ailed morbidity after thoracoscopic surgery is considered to be relate d to the minimal trauma associated with the access to lung tissue and the reduced handling of lung tissue.