100 CONSECUTIVE CASES OF VIDEO-ASSISTED THORACOSCOPIC SURGERY FOR PRIMARY SPONTANEOUS PNEUMOTHORAX

We reviewed our experience on video-assisted thoracoscopic surgery (VA TS) from our first 100 cases of primary spontaneous pneumothorax (PSP) performed at our institution from September 1992 to January 1994. Api cal bullae were identified in 87% of cases. Mechanical pleurodesis wit h Marlex mesh was performed on all patients. Excision with endoscopic staple cutter was performed in 69 cases; an endoloop was used in five cases; ablation with an argon beam coagulator (ABC) was done in six ca ses; excision with endoscopic suturing occurred in seven cases; and me chanical pleurodesis alone was used in 13 cases. The overall median po stoperative chest tube duration was 2 days (range 1-25 days) and hospi tal stay 4 days (range 1-30 days). Complications occurred in 8 cases ( 8%): 1 wound infection; 1 chest wall bleeding; and 6 persistent air le aks which lasted for more than 10 days (one of which eventually requir ed an axillary thoracotomy for control). Procedure failure with recurr ence occurred in three cases (3%) at a mean follow-up of 17 months (ra nge and 24 months). The ABC group alone was responsible for one recurr ence and two persistent leaks. We conclude that with the VATS approach in the treatment of PSP, staple resection of apical bullae is quick a nd most reliable but costly. Endoloop and hand suturing are applicable to selected patients with small and localized bullae and should be fu rther studied, while our limited experience does not favor ABC as the primary treatment modality.