3 YEARS EXPERIENCE IN VIDEO-ASSISTED THORACIC-SURGERY (VATS) FOR SPONTANEOUS PNEUMOTHORAX

In a prospective study (June 1990 to June 1993), 79 patients were trea ted for spontaneous pneumothorax by video-assisted thoracoscopic metho ds with regular follow-up. The observation time was from 3 to 36 month s (mean 19.6 months) and was more than 24 months in 27 patients. In 57 patients spontaneous pneumothorax was primary and in 22 secondary. Th e 53 male and 26 female patients were aged between 17 and 87 years (me an 37 years). Twenty-one patients were treated thoracoscopically for f irst episode, 22 for persistent pneumothorax (> 7 days), and 36 for a recurrence. Endoscopic examination failed to reveal any lung alteratio n in four patients (5.1%), and treatment then consisted of simple drai nage. Leaks were sealed 26 times by means of a Roeder loop with local anesthesia and 14 times by wedge resection with endotracheal anesthesi a and one-lung ventilation; 34 patients were treated by pleurectomy. N o deaths occurred, Surgical morbidity was 3.8%, and the postoperative complication rate was 5.1%. One patient was excluded from the follow-u p study after conversion to a thoracotomy for control of arterial blee ding. We noted six recurrences; four occurred in the first 21 days and three after ligation of the leak with a Roeder loop. We conclude that video-assisted thoracoscopic treatment of spontaneous pneumothorax by wedge resection and pleurectomy has a recurrence-free rate of 93.8% ( 45/48) and is therefore an effective treatment for all forms of sponta neous pneumothorax.