VIDEO-ASSISTED THORACOSCOPIC MANAGEMENT OF PRIMARY SPONTANEOUS PNEUMOTHORAX

Although Video-Assisted Thoracoscopic Surgery (VATS) is now accepted b y many as the approach of choice in the management of primary spontane ous pneumothorax (PSP), the optimal procedure and the timing of surgic al intervention remain areas of contention, The authors reviewed their combined experience with 518 consecutive VATS procedures for PSP in 4 83 patients. Mechanical pleurodesis was performed in every case and wa s the only procedure in 20 patients, We had experience with several me ans of eliminating subpleural bullae once identified: stapled bullecto my (196), endoloop (261), argon beam coagulation (6) and endoscopic su turing (35). There were no mortality or intraoperative complications, Median postoperative hospital stay was 3 days. So far, we have had 9 r ecurrences (1.74%), after a mean follow up of 20 months (range one to 36 months). Complications consisted of 18 persistent air leaks, 14 wou nd infections and 1 chest wall bleeding. We conclude that (1) VATS is a safe and effective approach in the treatment of PSP; (2) Stapled-bul lectomy is quick and reliable but costly; (3) Endoloop and suturing ar e viable alternative techniques that may prove to be more cost effecti ve; (4) we do nor recommend to use argon beam coagulation as the prima ry treatment modality.