Two-port versus three-port video-assisted thoracoscopic surgery for primary spontaneous pneumothorax: feasibility, postoperative outcome and long-term recurrence rates

Abstract Background Two-port VATS (2-P-VATS) and three-port VATS (3-P-VATS) are well-established techniques for surgical therapy of primary spontaneous pneumothorax (PSP). However, comparisons of both techniques in terms of postoperative outcome and recurrence are limited. Methods From January 2010 to March 2020, we retrospectively reviewed data of 58 PSP patients who underwent VATS in our institution. For statistical analysis, categorical and continuous variables were compared by chi-square test or Fisher’s exact test and the Student´s t-test, respectively. Twenty-eight patients underwent 2-P-VATS and 30 were treated with 3-P-VATS. Operation time, length of hospital stay (LOS), total dose of analgesics per stay (opioids and non-opioids), duration of chest tube drainage, pleurectomy volume (PV), postoperative complications and recurrence rates were compared between both groups. Results Clinical and surgical characteristics including mean age, gender, Body-Mass-Index (BMI), pneumothorax size, smoking behaviour, history of contralateral pneumothorax, side of pneumothorax, pleurectomy volume and number of resected segments were similar in both groups. The mean operation time, LOS and total postoperative opioid and non-opioid dose was significantly higher in the 3-P-VATS group compared with the 2-P-VATS group. Despite not being statistically significant, duration of chest tube was longer in the 3-P-VATS group compared with the 2-P-VATS group. In terms of postoperative complications, the occurrence of hemothorax was significantly higher in the 3-P-VATS group (3-P-VATS vs. 2-P-VATS; p = 0.001). During a median follow-up period of 61.6 months, there was no significant statistical difference in recurrence rates in both groups (2/28 (16.7%) vs. 5/30 (7.1%); p = 0.274). Conclusion Our data demonstrate that 2-P-VATS is safer and effective. It is associated with reduced length of hospital stay and decreased postoperative pain resulting in less analgesic use.

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Chest tube drainage versus video-assisted thoracoscopic surgery for a first episode of primary spontaneous pneumothorax: a systematic review and meta-analysis

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz116 ◽

2019 ◽

Vol 56 (5) ◽

pp. 819-829

Author(s):

Jean H T Daemen ◽

Pieter W J Lozekoot ◽

Jos G Maessen ◽

Michiel H M Gronenschild ◽

Gerben P Bootsma ◽

...

Keyword(s):

Chest Tube ◽

Spontaneous Pneumothorax ◽

Thoracoscopic Surgery ◽

Meta Analysis ◽

Primary Spontaneous Pneumothorax ◽

Chest Tube Drainage ◽

Recurrence Rates ◽

Tube Drainage ◽

Ipsilateral Recurrence ◽

Length Of Hospitalization

Summary Primary spontaneous pneumothorax affects up to 28 patients per 100 000 population yearly and is commonly resolved by chest tube drainage. However, drainage is also known to be associated with ipsilateral recurrence rates ranging from 25% to 43%. Preventive video-assisted thoracoscopic surgery (VATS) may be an effective alternative to diminish these recurrence rates and its associated morbidity. The aim of this study was to compare the efficacy of chest tube drainage and VATS as first line treatments of an initial episode of primary spontaneous pneumothorax. The MEDLINE, EMBASE, CENTRAL and Clinicaltrials.gov databases were searched through 16 September 2018. Data regarding the ipsilateral recurrence rate and the length of hospitalization were extracted and submitted to meta-analysis using the random-effects model and the I2 test for heterogeneity. Two randomized controlled trials and 2 observational studies were included, enrolling a total of 479 patients. Pairwise analysis demonstrated significantly reduced ipsilateral recurrence rates [odds ratio 0.15, 95% confidence interval (CI) 0.07–0.33; P < 0.00001] and length of hospitalization (standardized mean difference −2.19, 95% CI −4.34 to −0.04; P = 0.046) in favour of VATS. However, a significant level of heterogeneity was detected for the length of hospitalization (I2 = 97%; P < 0.00001). Subgroup analysis that stratified study design found no statistical differences regarding recurrence rate. In conclusion, VATS can be an effective and attractive alternative to standard chest tube drainage, with reduced ipsilateral recurrence rates and length of hospitalization. However, given the low quality of the majority of included studies, more well-designed randomized controlled trials are necessary to strengthen the current evidence.

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A comparative study of the fracture union between long and short proximal femoral intramedullary nails antirotation in the treatment of intertrochanteric femur fractures in the elderly: a multicentric analysis

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20190793 ◽

2019 ◽

Vol 5 (2) ◽

pp. 288

Author(s):

B. Hari Krishnan ◽

S. K. Rai ◽

Rohit Vikas ◽

Manoj Kashid ◽

Pramod Mahender

Keyword(s):

Postoperative Complications ◽

Blood Transfusion ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Operation Time ◽

The Elderly ◽

Intertrochanteric Fractures ◽

Intraoperative Blood Loss ◽

Fracture Union ◽

Femur Fractures

Background: The objective of the study was to compare the fracture union of long vs. short proximal femoral intramedullary nail antirotation (PFNA) in the treatment of intertrochanteric fractures in elderly patients who was more than 60 years old.Methods: A retrospective analysis of 170 cases of intertrochanteric fractures of the femur (AO type A1 and A2) in the elderly was conducted. There were 64 males (37.6%) and 106 females (62.3%) with the age of 60–90 (mean age 75) years. The general demographic data of patients, operation time, intraoperative blood loss, length of hospital stay, blood transfusion rate, anterior thigh pain, postoperative complications like periprosthetic fractures, infections were recorded.Results: The short nail group also had a significantly shorter operation time (41.5±15.3 minutes vs. 62.5±25.3 minutes, p=0.002) and lower rate of postoperative transfusion (31.3% vs. 58.7%, p=0.041). However the length of hospital stay showed no significant differences. After surgery in short group there were 03 cases of periprosthetic fracture with a total incidence of 03%, however there were none in long nail group. At the end of the follow-up, all patients achieved bony union. The average fracture union time of the long nail group was (8.5±3.2) months, and the short nail group was (7.8±4.7) months, revealing no significant differences (p=0.09).Conclusions: Both the proximal femoral intramedullary long and short nail fixation has a good result in the form of fracture union in treating intertrochanteric femur fractures in the elderly. They showed no significant difference in terms of fracture union, hospital stay, and postoperative complications. The incidence of periprosthetic fractures and anterior thigh pain was slightly high in short nail group. In short intramedullary nailing group there was obvious decrease in the intraoperative blood loss, operation time and postoperative blood transfusion.

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Can Awake Thoracoscopy Procedure be Performed with the Help of Thoracic Paravertebral Anesthesia?

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v17i4.38319 ◽

2018 ◽

Vol 17 (4) ◽

pp. 576-582

Author(s):

Fazli Yanik ◽

Yekta Altemur Karamustafaoglu ◽

Elif Copuruoglu ◽

Gonul Sagiroglu

Keyword(s):

Hospital Stay ◽

Thoracoscopic Surgery ◽

Wedge Resection ◽

Medical Science ◽

Oral Intake ◽

Length Of Hospital Stay ◽

Operation Time ◽

Early Mobilization ◽

Talc Pleurodesis ◽

The Mean

Aim:The aim of this study was to present our experience with 11 patients who were spontaneously breathing with Awake Video Thoracoscopy (AVATS) procedure with the help of TPB because of rareness in the literature.Materials and Methods: Between December 2015 and December 2017, a total of 125 VATS cases were performed; 11 cases underwent VATS operation with the help of TPB; age, gender, operation performed, duration of operation, time of onset of mobilization-oral intake, duration of hospital stay, Visual Analogue Scale (VAS) scores were evaluated retrospectively.Results: All cases were treated with uniportal AVATS procedure with the help of TPB. The mean age was 40,3 ± 17,4 years (range 18-64 years ), nine (82%) of the pateints were male and two (18%) were female. Operation procedures included wedge resection in eight (73 %) patients (six of them for pneumothorax, two of them for diagnosis), in three (27%) patients pleural biopsy (one of them used talc pleurodesis).There were no perioperative events. The mean operation time was 27,7 ± 6,4 minutes (range, 20-40 min) and the mean anesthesia time was 25 ± 3,8 minutes (range 20-30 min).The mean time of mobilizitation, oral intake opening time and length of hospital stay was 1,1 ± 0,4 hours (1-2 hours), 3,5 ± 0,5 hours (3-4 hours), 2,6 ± 0,5 days (2-3 days), respectively.Conclusion:Awake Video Asssited Thoracoscopic Surgery with the help of TPB has less side effects and less complication risks than other awake procedures with the help of other regional anesthesia techniques. We conclude that; although AVATS with the help of TPB has some minor complications, it has advantages such as early discharge, early mobilization and early oral intake, low pain levels in well-selected patient groups.Bangladesh Journal of Medical Science Vol.17(4) 2018 p.576-582

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Postoperative Clinical Outcomes of Thoracoscopic Surgery under Local Anesthesia in Patients with Primary Spontaneous Pneumothorax

Applied Sciences ◽

10.3390/app11041468 ◽

2021 ◽

Vol 11 (4) ◽

pp. 1468

Author(s):

Eunji Kim ◽

Chi-Seung Lee ◽

Jeong Su Cho ◽

Hoseok I ◽

Yeong Dae Kim ◽

...

Keyword(s):

Surgical Technique ◽

Clinical Outcomes ◽

Local Anesthesia ◽

Spontaneous Pneumothorax ◽

Thoracoscopic Surgery ◽

Wedge Resection ◽

Operation Time ◽

Postoperative Recurrence ◽

Primary Spontaneous Pneumothorax ◽

Anesthetic Technique

(1) Background: since the technologies of anesthesia and surgery were advanced, video-assisted thoracic surgery (VATS) under local anesthesia (LA) has been widely carried out and is considered a robust surgical technique to prevent the recurrence of pneumothorax in patients with recurrent primary spontaneous pneumothorax (PSP). In this study, postoperative clinical outcomes were compared to evaluate the feasibility and efficacy of VATS under LA compared with general anesthesia (GA) in patients with PSP. (2) Methods: 255 patients underwent wedge resection underwent VATS for PSP in our hospital from January 2014 to June 2019. Of them, 30 patients underwent the operation under LA and the others underwent the operation under GA. Except for the anesthesia method, the same surgical technique was adopted for all patients. All medical records were retrospectively reviewed. (3) Results: the total operation time and total hospital days were relatively shorter, post-chest tube drainage was significantly shorter (0.04), and visual analog scale (VAS) scores in the outpatient clinic were significantly lower in the LA group than in the GA group (p = 0.01). The incidence of postoperative recurrence after discharge in the LA group (3.3%) was also lower than in the GA group (18.67%) (p = 0.001). In the LA group, there were no cases of conversion to intubation. (4) Conclusions: our results showed relatively better clinical outcomes in VATS under LA with sedation than under GA in the treatment of PSP. Hence, LA with sedation can be considered as a robust anesthetic technique for VATS and as applicable in the surgical treatment of PSP.

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Recommendation for management of patients with their first episode of primary spontaneous pneumothorax, using video-assisted thoracoscopic surgery or conservative treatment

Scientific Reports ◽

10.1038/s41598-021-90113-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Hsin-Yi Chiu ◽

Yi-Chia Ho ◽

Pei-Chen Yang ◽

Chi-Ming Chiang ◽

Cheng-Chin Chung ◽

...

Keyword(s):

Conservative Treatment ◽

Hospital Stay ◽

Recurrence Rate ◽

Complication Rate ◽

Spontaneous Pneumothorax ◽

Thoracoscopic Surgery ◽

Primary Spontaneous Pneumothorax ◽

Grade System ◽

Current Evidence ◽

First Episode

AbstractInternational guidelines do not recommend surgery for the first episode of primary spontaneous pneumothorax (PSP), except in cases of persistent air leak, hemopneumothorax, bilateral pneumothorax, or occupations at risk. However, these recommendations have been challenged because of a significant reduction in the recurrence rate in emerging studies. We evaluated the rationale of recommendations by systematically reviewing RCTs and observational studies by using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. We searched articles in PubMed, EMBASE, and Cochrane databases up to August 15, 2020. The primary outcomes were the recurrence rate and complication rate. The secondary outcomes were hospital stay and drainage duration. Nine eligible studies with 1121 patients were retrieved and analyzed. The recurrence rate was lower in the VATS than in conservative treatment with moderate evidence (OR 0.13, 95% CI 0.09 to 0.19, P < 0.001, I2 = 0%). We did not find significant differences in complication rate (Peto OR 1.17, 95% CI 0.33 to 4.12, P = 0.80), hospital stay duration (MD − 0.48 days, 95% CI − 2.84 to 1.87, P = 0.69, very low evidence), and in drainage duration (MD − 3.99 days, 95% CI − 9.06 to 1.08, P = 0.12, very low evidence) between the two groups. Our results would suggest VATS treatment as a weak recommendation for patients with the first episode of PSP, based on our systematic review of the current evidence by using the GRADE system, indicating that different treatments will be appropriate for different patients and that patients’ values and preferences should be incorporated through shared decision making.Trial REGISTRY: PROSPERO; No.: CRD42020162267.

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Outcome Comparison between Video Assisted Thoracoscopic Surgery and Open Thoracotomy on Primary Spontaneous Pneumothorax in a Tertiary Hospital in Thailand

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.01.11510 ◽

2021 ◽

Vol 104 (1) ◽

pp. 100-104

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Spontaneous Pneumothorax ◽

Thoracoscopic Surgery ◽

Length Of Hospital Stay ◽

Cost Effective ◽

Open Thoracotomy ◽

Video Assisted ◽

Operative Outcome ◽

Video Assisted Thoracoscopic Surgery

Objective: To assess recurrence, complication after surgery, hospital stay, and cost-effective in primary spontaneous pneumothorax (PSP) patients of Thai urban population that underwent video assisted thoracoscopic surgery (VATS) and open thoracotomy (OT). Materials and Methods: The present study was a retrospective cohort between 2006 and 2019. Seventy-five patients were diagnosed as PSP. All medical records were collected from Vajira Hospital. All various factors were analyzed to evaluate an outcome between the two groups. Results: Fifty-four patients were treated by VATS, whereas 21 patients were treated by OT. The mean follow-up time was 26 months. There was no difference in term of gender, indication of surgery, and cost during hospital stay between the two groups. Length of hospital stay were shorter in VATS groups (9.5 days versus 15 days, p=0.006). The operative time was longer and more blood loss in OT groups compared to VATS groups (180 minutes versus 70 minutes, p<0.001 and 100 mL versus 30 mL, p<0.001). In post-operative outcome, there was no difference in terms of recurrence, pneumonia, and re-operation. Conclusion: VATS is associated with shorter length of hospital stay and less blood loss with no difference of cost effective, recurrence, and post-operative outcome in PSP patients. Keywords: Video assisted thoracoscopic surgery, Pneumothorax, Open thoracotomy

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Socioeconomic Impact of Recurrent Primary Spontaneous Pneumothorax: Should Video-Assisted Thoracoscopic Surgery Be Considered at First Episode of Primary Spontaneous Pneumothorax?

Healthcare ◽

10.3390/healthcare9091236 ◽

2021 ◽

Vol 9 (9) ◽

pp. 1236

Author(s):

Stephen Fung ◽

Andrea Alexander ◽

Hany Ashmawy ◽

Levent Dizdar ◽

Sami Safi ◽

...

Keyword(s):

Healthcare System ◽

Chest Tube ◽

Spontaneous Pneumothorax ◽

Thoracoscopic Surgery ◽

Primary Spontaneous Pneumothorax ◽

Socioeconomic Impact ◽

First Episode ◽

Air Leak ◽

Video Assisted ◽

Video Assisted Thoracoscopic Surgery

Background: Current guidelines recommend video-assisted thoracoscopic surgery (VATS) for recurrent primary spontaneous pneumothorax (PSP) and for cases with persistent air leak after chest tube treatment. The socioeconomic impact of recurrent PSP on the healthcare system is insufficiently reported. Methods: Ninety-six patients treated for PSP between 01/2010 and 01/2020 were included. Forty-eight patients underwent primary VATS, while the second group received chest tube (CT) treatment only. Length of hospital stay (LOS), duration of chest tube, prolonged air leak, postoperative complications, recurrences and treatment costs were analyzed. Results: Prolonged air leaks were evident in 12.5% and 22.9% patients of the VATS and CT group, respectively. Ten (20.8%) patients in the CT group underwent VATS for persistent air leakage. During follow-up, the VATS group recurred at 8.3% compared to 52.1% in the CT group. The total cost of treatment per patient, including treatment cost due to recurrence, was EUR 1.501 in the VATS group and EUR 2.233 in the CT group. Conclusions: Primary treatment of PSP by CT is associated with an increased socioeconomic burden for patients and the healthcare system due to high recurrence rates. This burden may be reduced if VATS is considered at the first episode of PSP.

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Curative Effect Observation and Prognosis Analysis of Video-Assisted Thoracic Surgery and Thoracotomy in Patients with Hemopneumothorax

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2021/3937420 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Honglei Zhang ◽

Qian Yang ◽

Tao Liu ◽

Yu Liu

Keyword(s):

Postoperative Complications ◽

Hospital Stay ◽

Retention Time ◽

Chest Tube ◽

Operation Time ◽

Postoperative Recovery ◽

Inflammatory Factor ◽

Intraoperative Bleeding ◽

Video Assisted

Currently, the incidence of hemopneumothorax is high in China, and with the continuous improvement of modern medical standards, video-assisted thoracoscopic surgery (VATS) has gradually become the main method of clinical treatment of hemopneumothorax. The aim of this study was to investigate the minimally invasive mechanism and the clinical value of television thoracoscopy in the diagnosis and treatment of traumatic hemopneumothorax and to provide a relevant theoretical basis for the superiority of television thoracoscopy. In this study, total of 98 patients with traumatic hemopneumothorax admitted to three hospitals from January 2017 to December 2019 were selected and divided into 49 cases each in the thoracotomy group and VATS group according to the differences of the surgical method. The surgical situation such as operation time, intraoperative bleeding, and incision length, postoperative recovery such as duration of painkiller use, chest tube retention time, volume of drainage, and hospital stay, levels of C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and other inflammatory factors at different times after admission to hospital, postoperative complications such as pulmonary infection, enveloped effusion, incisional infection, and pressureulcers, and recurrence rate at 12-month follow-up were used as the evaluation indexes to analyze the effect of different surgical treatment modalities in patients with hemopneumothorax and the impact on patient prognosis. The results showed that the operative time, intraoperative bleeding, duration of painkiller use, chest tube retention time, and hospital stay were shorter in the VATS group than in the thoracotomy group. The length of the surgical incision, volume of drainage, and inflammatory factor levels at different postoperative periods were lower in the VATS group than in the thoracotomy group. The incidence of postoperative complications was lower in both groups, and the difference was not statistically significant. The follow-up results showed that there were no recurrent cases in both groups 12 months after discharge. This indicates that VATS is an effective treatment option for hemopneumothorax, which can achieve the same exploration and treatment effect as thoracotomy, and has the advantages of less trauma, less bleeding, shorter operation time, and faster postoperative recovery compared with thoracotomy. The prognosis of patients treated by VTAS is good, which provides a new treatment route for patients who cannot tolerate thoracotomy and are poorly tolerated.

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Digital versus analogue chest drainage system in patients with primary spontaneous pneumothorax: a randomized controlled trial

10.21203/rs.3.rs-15873/v1 ◽

2020 ◽

Author(s):

Kris Mooren ◽

Dieuwertje Ruigrok ◽

Peter W.A. Kunst ◽

Marielle M.J. Blacha ◽

Ben Tomlow ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Hospital Stay ◽

Chest Tube ◽

Spontaneous Pneumothorax ◽

Controlled Trial ◽

Drainage System ◽

Length Of Hospital Stay ◽

Air Leakage ◽

Chest Drainage ◽

Randomized Controlled

Abstract Background Patients with a primary spontaneous pneumothorax (PSP) who are treated with chest tube drainage are traditionally connected to an analogue chest drainage system, containing a water seal and using a visual method of monitoring air leakage. Electronic systems with continuous digital monitoring of air leakage provide better insight into actual air leakage and changes in leakage over time, which may lead to a shorter length of hospital stay. Aim and methods We performed a randomized controlled trial comparing the digital with analogue system, with the aim of demonstrating that use of a digital drainage system in PSP leads to a shorter hospital stay. Results In 102 patients enrolled with PSP we found no differences in total duration of chest tube drainage and hospital stay between the groups. However, in a post-hoc analysis, excluding 19 patients needing surgery due to prolonged air leakage, hospital stay was significantly shorter in the digital group (median 1 days, IQR 1-5 days) compared to the analogue group (median 3 days, IQR 2-5 days) (p 0.014). Treatment failure occurred in 3 patients in both groups; the rate of recurrence within 12 weeks was not significantly different between groups (16% in the digital group versus 8% in the analogue group, p 0.339). Conclusion Length of hospital stay was not shorter in patients with PSP when applying a digital drainage system compared to an analogue drainage system. However, in the large subgroup of uncomplicated PSP, a significant reduction in duration of drainage and hospital stay was demonstrated with digital drainage. These findings suggests that digital drainage may be a practical alternative to manual aspiration in the management of PSP. Trial registration: https://www.trialregister.nl/trial/4022. Registered 22 September 2013 - Retrospectively registered, Trial NL4022 (NTR4195)

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Digital versus analogue chest drainage system in patients with primary spontaneous pneumothorax: a randomized controlled trial

10.21203/rs.3.rs-15873/v3 ◽

2020 ◽

Author(s):

Kris Mooren ◽

Dieuwertje Ruigrok ◽

Peter W.A. Kunst ◽

Marielle M.J. Blacha ◽

Ben Tomlow ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Hospital Stay ◽

Chest Tube ◽

Spontaneous Pneumothorax ◽

Controlled Trial ◽

Drainage System ◽

Length Of Hospital Stay ◽

Air Leakage ◽

Chest Drainage ◽

Randomized Controlled

Abstract Background Patients with a primary spontaneous pneumothorax (PSP) who are treated with chest tube drainageare traditionally connected to an analogue chest drainage system, containing a water seal and using a visual method of monitoring air leakage. Electronic systems with continuous digital monitoring of air leakage provide better insight into actual air leakage and changes in leakage over time, which may lead to a shorter length of hospital stay.Methods We performed a randomized controlled trial comparing the digital with analogue system, with theaim of demonstrating that use of a digital drainage system in PSP leads to a shorter hospital stay.Results In 102 patients enrolled with PSP we found no differences in total duration of chest tube drainageand hospital stay between the groups. However, in a post-hoc analysis, excluding 19 patients needing surgery due to prolonged air leakage, hospital stay was significantly shorter in the digital group (median 1 days, IQR 1-5 days) compared to the analogue group (median 3 days, IQR 2-5 days) (p 0.014). Treatment failure occurred in 3 patients in both groups; the rate of recurrence within 12 weeks was not significantly different between groups (16% in the digital group versus 8% in the analogue group, p 0.339).Conclusion Length of hospital stay was not shorter in patients with PSP when applying a digital drainage system compared to an analogue drainage system. However, in the large subgroup of uncomplicated PSP, a significant reduction in duration of drainage and hospital stay was demonstrated with digital drainage. These findings suggest that digital drainage may be a practical alternative to manual aspiration in the management of PSP. Trial registration: https://www.trialregister.nl/trial/4022. Registered 22 September 2013 - Retrospectively registered, Trial NL4022 (NTR4195)

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