VIDEO-ASSISTED THORACIC-SURGERY - PRIMARY THERAPY FOR SPONTANEOUS PNEUMOTHORAX

Background. This study assessed the role of video-assisted thoracic su rgery (VATS) in current therapy for spontaneous pneumothorax. Methods. We compared a retrospective series of 89 patients treated conventiona lly with a consecutive group of 30 patients undergoing VATS pleural ab rasion. The 89 earlier patients were predominantly male (81%). Treatme nt groups included observation/aspiration (7 or 17%), tube thoracostom y (32 or 36%), multiple tubes (7 or 9%), and thoracotomy (43 or 48%). Of the 30 patients treated with VATS, 18 (66%) were male. Primary indi cations for operation were recurrent pneumothorax (17) and persistent air leak (9). Results. Hospital lengths of stay (LOS) for the earlier group were 5 days for simple tube and 7 days for primary thoracotomy; LOS for initial intervention followed by thoracotomy exceeded 15 days in all subgroups. The average LOS in the VATS group was 13 days; 6 pat ients treated with primary VATS (no chest tube) had a mean LOS of 6.5 days. Complications included 3 (10%) prolonged air leaks (more than 7 days) and 2 (7%) early recurrences. Conclusions. We do not recommend V ATS as primary therapy for spontaneous pneumothorax; tube thoracostomy remains the treatment of choice. However, we strongly support surgica l intervention early (3 days) in patients with a persistent air leak, and as primary therapy in a nonurgent situation if standard indication s exist. This study shows no advantage of VATS over conventional thora cotomy in hospital stay or complication rate.