MINIMALLY INVASIVE MANAGEMENT FOR FIRST AND RECURRENT PNEUMOTHORAX

Minimally invasive techniques for treatment of pneumothorax should yie ld the standard of results set with open procedures: the operative mor bidity should remain less than 15%, and the recurrence rate less than 1%. In the era before video-assisted thoracic surgery, two minimally i nvasive variants were used. Chemical pleurodesis resulted in an unsati sfactory recurrence rate of at least 15%. In contrast, pleurectomy and apical stapling performed through a transaxillary minithoracotomy com pared favorably with larger thoracotomy approaches, and allowed a redu ced hospital stay. Evaluation of video-assisted thoracic surgical oper ations for spontaneous pneumothorax is hampered by a lack of controlle d studies. The general impression is that morbidity did not decline si gnificantly; the main determinant of complications is the patient's un derlying health status. However, published recurrence rates range from 5% to 10%, in spite of a shorter follow-up time span. Optimized resul ts are achieved when classic principles combining apical wedge resecti on and pleurodesis are applied. Reduction of hospital stay is not only a result of the new technology, but also changing drainage and discha rge policies. Reduction of cost is debatable, because many studies do not consider the cost of video equipment. The main advantage when comp ared with open thoracotomy is reduction of postoperative pain. The onl y two available controlled studies conclude that there is no obvious a dvantage of video-assisted thoracic surgery when compared with convent ional limited-access surgery. The future role of video-assisted thorac ic surgery in this disease remains to be determined by a large-scale p rospective evaluation. (C) 1998 by The Society of Thoracic Surgeons.