scholarly journals Uniportal VATS technique for primary spontaneous pneumothorax: An analysis of 46 cases

2019 ◽  
Vol 36 (2) ◽  
Author(s):  
Hasan Oğuz Kapicibasi
Keyword(s):  
Spontaneous Pneumothorax ◽  
Surgical Intervention ◽  
Thoracoscopic Surgery ◽  
Wedge Resection ◽  
Primary Spontaneous Pneumothorax ◽  
First Episode ◽  
Histopathological Diagnosis ◽  
Air Leakage ◽  
Creative Commons ◽  
Duration Of Hospitalization

Objective: In the treatment of primary spontaneous pneumothorax (PSP), the influence of safety and applicability of uniportal video assisted thoracoscopic surgery (VATS) bullectomy/blebectomy and pleurectomy method were evaluated in 46 patients. Methods: Between November 2010 and January 2019, 46 patients (36 males, 10 females; mean age 24.2 years; range 16-36 years) undergoing uniportal video thoracoscopic bullectomy/blebectomy and apical pleurectomy for primary spontaneous pneumothorax were evaluated retrospectively at Canakkale Onsekiz Mart University (COMU). One patient underwent surgery for the second time after three months for contralateral pneumothorax and counted as two different patients, hence forty seven operations were performed in total. The cases were evaluated in terms of age, gender, comorbidity, duration of hospital stay, histopathological diagnosis, postoperative morbidity and mortality. Results: Right surgical intervention was performed in 20 cases (42.6%) and left surgical intervention in 27 cases (57.6%). A total of 15 (31.9%) surgical operations were performed during the first attack, 30 (63.8%) during the second attack and 2 (4.3%) during third and more attacks. There was prolonged air leakage in all patients operated during the first episode. All cases underwent wedge resection and pleurectomy with endoscopic stapes. None of the patients required thoracotomy. Postoperative drainage period was between 2-7 days (mean: 4.1) and the duration of hospitalization was between three to eight days. Postoperative pain and paraesthesia were observed in eight cases. Prolonged air leakage was observed in five cases. Conclusion: With video thoracoscopic uniportal technique, not only lung biopsy and resection but also bullectomy/blebectomy and pleurectomy operations can be performed safely in the treatment of PSP. In view of this information, minimally invasive techniques are seen as more advantageous than conventional techniques. doi: https://doi.org/10.12669/pjms.36.2.1556 How to cite this:Kapicibasi HO. Uniportal VATS technique for primary spontaneous pneumothorax: An analysis of 46 cases. Pak J Med Sci. 2020;36(2):---------. doi: https://doi.org/10.12669/pjms.36.2.1556 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Pleurodesis methods in the surgical treatment of primary spontaneous pneumothorax

2021 ◽  
pp. 77-81
Keyword(s):  
Surgical Treatment ◽  
Recurrence Rate ◽  
Spontaneous Pneumothorax ◽  
Thoracoscopic Surgery ◽  
Wedge Resection ◽  
Primary Spontaneous Pneumothorax ◽  
High Recurrence Rate ◽  
Parietal Pleura ◽  
Advantages And Disadvantages ◽  
Video Assisted Thoracoscopic Surgery

Pneumothorax is the collection of air in the pleural space. Pneumothorax can be spontaneous, traumatic or iatrogenic. Primary spontaneous pneumothorax mostly occurs in healthy individuals without an apparent cause, probably due to the rupture of subpleural emphysematous bullae located on the apex of the lung. It usually occurs in tall and healthy males younger than 40 years old. Primary spontaneous pneumothorax has a recurrence rate of 20-30% after the first attack, 50% after the second attack, and 80% after the third attack. Surgery is presented as a treatment option to reduce the high recurrence rate after the second attack. It has been reported that recurrence is between 10 and 20% in patients who undergo bullectomy or wedge resection with endoscopic steps alone. Therefore, various pleural pleurodesis methods are applied in addition to bulla resection in order to reduce the recurrence rate after surgery. In mechanical pleurodesis, adhesion between visceral and parietal pleura is achieved by mechanical abrasion of the parietal pleura or by total or partial removal of the parietal pleura. In chemical pleurodesis, the visceral pleura is adhered to the parietal pleura by creating irritation in the pleura with chemical agents. In cases where pleurodesis was added, the recurrence rate was reported to be between 1.7 and 2.8%. Whether the pleurectomy, pleural mechanical or chemical abrasion methods performed with video-assisted thoracoscopic surgery is superior for preventing recurrence is still a matter of debate. In this article, we aimed to discuss the advantages and disadvantages of pleurodesis methods in the surgical treatment of primary spontaneous pneumothorax in the light of the literature.

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

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.

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

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.

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

Healthcare ◽  
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.

scholarly journals Cannabis Use Is Associated With Recurrence After Primary Spontaneous Pneumothorax

2021 ◽  
Vol 8 ◽  
Author(s):  
Connor J. Wakefield ◽  
Christopher W. Seder ◽  
Andrew T. Arndt ◽  
Nicole Geissen ◽  
Michael J. Liptay ◽  
...  
Keyword(s):  
Tobacco Use ◽  
Spontaneous Pneumothorax ◽  
Thoracoscopic Surgery ◽  
Wedge Resection ◽  
Disease Recurrence ◽  
Cannabis Use ◽  
Primary Spontaneous Pneumothorax ◽  
High Rate ◽  
Exact Test ◽  
Lost To Follow Up

Purpose: Primary spontaneous pneumothorax (PSP) is a frequently encountered entity that carries a high rate of recurrence. The current study aims to investigate if cannabis use at time of initial PSP is associated with disease recurrence.Methods: Patients presenting with PSP between 2010 and 2018 at a single institution were identified. Exclusion criteria included secondary pneumothorax, severe chronic lung disease, lung cancer, and lost to follow-up. Patients were compared relative to their cannabis usage with Fisher's exact test, Wilcoxon rank-sum test, and logistic regression.Results: Overall, 67 patients (53 male) met inclusion criteria with a median body mass index (BMI) of 21.5 kg/m2 (IQR 19.1–25.2) and age of 34 years (IQR 22–53). Initial treatment consisted of chest tube in 42 patients (63%), video-assisted thoracoscopic surgery wedge resection in 19 patients (28%), and observation in 6 patients (9%). Cannabis users (n = 28; 42%) had a higher rate of tobacco use (79 vs. 38%; p = 0.005), lower BMI [21.0 kg/m2 (IQR 18.3–23.1) vs. 22.2 kg/m2 (IQR 19.9–28.6), p = 0.037], and were more likely to require intervention at first presentation compared with non-marijuana users. Cannabis use was associated with PSP recurrence when adjusting for tobacco use, BMI, and height (OR 1.85, 95% CI 1.38–18.3, p = 0.014).Conclusion: There is a high rate of cannabis usage in patients presenting with PSP. Cannabis usage is associated with PSP recurrence and eventual need for operative intervention.

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