Video-assisted Thoracoscopic Surgery Versus Axillary Thoracotomy in Primary Spontaneous Pneumothorax

Document Type: Original Article

Authors

1 Thoracic surgeon, Cardio-Thoracic Surgery & Transplant Research Center, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Pulmonologist, Lung Disease Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 General Practitioner, Cardio-Thoracic Surgery & Transplant Research Center, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

4 General Surgeon, Cardio-Thoracic Surgery & Transplant Research Center, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

5 Student of Medical Science, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Introduction: Video-assisted thoracic surgery (VATS) is now commonly used for primary spontaneous pneumothorax. In the present study we compared the outcomes of this technique with those obtained by conventional thoracotomy.
Material and Methods: In this cross-sectional stud, forty patients were enrolled into two groups: VATS (n=20) and thoracotomy (n=20). In both groups the blebs were resected and pleural abrasion was performed with putting a mesh on the apical surface of the parietal pleura, finalized by patchy pleurectomy and mechanical abrasion with gas. Two groups were appropriately matched for age, gender, side of bleb, indication for surgery, and the smoking habits. As outcome measures, the conversion from VATS to thoracotomy and the early complications including wound infection, air leakage and intraoperative bleeding were assessed. After discharge, follow up schedule included visits at one, three, six months and one year post-operation to evaluate the recurrence rate.
Results: Mean age of these forty patients (34 males and 6 females) was 28.4±8.74 years. There was no conversion from VATS to thoracotomy group. The complications, including prolonged air leakage and wound infection, were seen in three patients of each group (totally 6 patients) (P=0.712). One patient in VATS group experienced the recurrence (P=0.235). Average admission time was 5±0.79 days in the VATS and 5.65±0.81 days in the thoracotomy group (P=0.043), duration of surgery in the open thoracotomy and VATS groups were 76±5.52 and 48.35±4.35 min, respectively (P<0.001) and intra-operative bleeding in the open thoracotomy and VATS groups were 127.5±10.69 and 112.5±8.5 mL, respectively (P<0.001) these three factors were significantly less in the VATS group.
Conclusion: VATS seems to be superior to thoracotomy, when it is indicated due to the recurrence or other reasons, because in spite of the similar therapeutic efficacy and recurrence rate, VATS is associated with less tissue damage and shorter hospital stay.

Keywords


  1. Chan P, Clarke P, Daniel FJ, Knight SR, Seevanayagam S. Efficacy study of video-assisted thoracoscopic surgery pleurodesis for spontaneous pneumothorax. Ann Thorac Surg. 2001; 71:452-4.
  2. Gupta D, Mishra S, Faruqi S, Aggarwal AN. Aetiology and clinical profile of spontaneous pneumothorax in adults. Indian J Chest Dis Allied Sci. 2006; 48:261-4.
  3. Sawada S, Watanabe Y, Moriyama S. Video-assisted thoracoscopic surgery for primary spontaneous pneumothorax: evaluation of indications and long-term outcome compared with conservative treatment and open thoracotomy. Chest. 2005; 127:2226-30.
  4. Baumann MH, Strange C. Treatment of spontaneous pneumothorax: a more aggressive approach? Chest. 1997; 112:789-804.
  5. Ferraro P, Beauchamp G, Lord F, Emond C, Bastien E. Spontaneous primary and secondary pneumothorax: a 10-year study of management alternatives. Can J Surg. 1994; 37:197-202.
  6. Donahue DM, Wright CD, Viale G, Mathisen DJ. Resection of pulmonary blebs and pleurodesis for spontaneous pneumothorax. Chest. 1993; 104:1767-9.
  7. Janssen J, van Mourik J, Cuesta Valentin M, Sutedja G, Gigengack K, Postmus PE. Treatment of patients with spontaneous pneumothorax during videotho-racoscopy. Eur Respir J. 1994; 7(7):1281-4.
  8. Naunheim KS, Mack MJ, Hazelrigg SR, Ferguson MK, Ferson PF, Boley TM, et al. Safety and efficacy of video-assisted thoracic surgical techniques for the treatment of spontaneous pneumothorax. J Thorac Cardiovasc Surg. 1995; 109:1198-204.
  9. Foroulis CN, Anastasiadis K, Charokopos N, Antonitisis P, Halvatzoulis HV, Karapanagiotidis GT, et al. A modified two-port thoracoscopic technique versus axillary minithoracotomy for the treatment of recurrent spontaneous pneumothorax: a prospective randomized study. Surg Endosc. 2012; 26:607-14.
  10. Kim KH, Kim HK, Han JY, Kim JT, Won YS, Choi SS. Transaxillary minithoracotomy versus video-assisted thoracic surgery for spontaneous pneumothorax. Ann Thorac Surg. 1996; 61:1510-2.
  11. Passlick B, Born C, Häussinger K, Thetter O. Efficiency of video-assisted thoracic surgery for primary and secondary spontaneous pneumothorax. Ann Thorac Surg. 1998; 65:324-7.
  12. Smit HJ, Wienk MA, Schreurs AJ, Schramel FM, Postmus PE. Do blebs indicate a predisposition to recurrent pneumothorax? Br J Radiol. 2000; 73:356-9.
  13. Levi JF, Kleinmann P, Riquet M, Debesse B. Percutaneous parietal pleurectomy for recurrent spontaneous pneumothorax. Lancet. 1990; 336:1577-8.
  14. Freixinet J, Canalis E, Rivas JJ, Rodriguez de Castro F, Torres J, Gimferrer J, et al. Surgical treatment of primary spontaneous pneumothorax with video-assisted thoracic surgery. Eur Respir J. 1997; 10:409-11.
  15. Mouroux J, Elkaïm D, Padovani B, Myx A, Perrin C, Rotomondo C, et al. Video-assisted thoracoscopic treatment of spontaneous pneumothorax: technique and results of one hundred cases. J Thorac Cardiovasc Surg. 1996; 112:385-91.
  16. Freixinet JL, Canalís E, Juliá G, Rodriguez P, Santana N, Rodriguez de Castro F. Axillary thoracotomy versus videothoracoscopy for the treatment of primary spontaneous pneumothorax. Ann Thorac Surg. 2004; 78:417-20.
  17. Divisi D, Di Leonardo G, Crisci R. Video-assisted thoracic surgery versus pleural drainage in the management of the first episode of primary spontaneous pneumothorax. Am J Surg. 2015; 210(1):68-73.
  18. Gaensler EA. Parietal pleurectomy for recurrent spontaneous pneumothorax. Surg Gynecol Obstet. 1956; 102:293-308.
  19. Olavarrieta JR, Coronel P. Expectations and patient satisfaction related to the use of thoracotomy and video-assisted thoracoscopic surgery for treating recurrence of spontaneous primary pneumothorax. J Bras Pneumol. 2009; 35(2):122-8.
  20. Jimenez-Merchan R, Garcia-Diaz F, Arenas-Linares C, Girón-Arjona J, Congregado-Loscertales M, Loscertales J. Comparative retrospective study of surgical treatment of spontaneous pneumothorax. Surg Endosc. 1997; 11:919-22.
  21. Lu XC, Li XB. Application of video-assisted thoracoscope in treatment of first-episode primary spontaneous pneumothorax. J Huaihai Med. 2012; 1:4.
  22. Joshi V, Kirmani B, Zacharias J. Thoracotomy versus VATS: is there an optimal approach to treating pneumothorax? Ann R Coll Surg Engl. 2013; 95:61-4.
  23. Miller JD, Simone C, Kahnamoui K, Thomas J, Bennett WF, Young JE, et al. Comparison of videothoracoscopy and axillary thoracotomy for the treatment of spontaneous pneumothorax. Am Surg. 2000; 66(11):1014-5.
  24. Ben-Nun A, Soudack M, Best LA. Video-assisted thoracoscopic surgery for recurrent spontaneous pneumothorax: the long-term benefit. World J Surg. 2006; 30:285-90.
  25. Shaikhrezai K, Thompson AI, Parkin C, Stamenkovic S, Walker WS. Video-assisted thoracoscopic surgery management of spontaneous pneumothorax–long-term results. Eur J Cardiothoracic Surg. 2011; 40:120-3.