Original ArticlesEfficiency of Video-Assisted Thoracic Surgery for Primary and Secondary Spontaneous Pneumothorax
Section snippets
Patients and Criteria of Evaluation
This retrospective study was performed on an initial series of 99 consecutive patients with PSP or SSP who were treated primarily by VATS (VATS group) between April 1992 and December 1995. All hospital charts were reviewed and analyzed according to the following parameters: preoperative data (sex, age, underlying disease, smoking history, length of preoperative hospital stay, preoperative treatment modalities, number of previous recurrences); intraoperative findings (number and site of
Conversion to Thoracotomy
Extension of the trocar incisions or conversion to a limited lateral thoracotomy was necessary in 6 (9.2%) patients with PSP and in 10 (29.4%) patients with SSP (p = 0.001), in most instances because of massive adhesions (Table 1). In 1 patient with SSP, a large apical bulla was not resectable by VATS alone and required lateral thoracotomy to allow adequate overview. Bleeding at one of the trocar sites was controlled in 2 patients with PSP by minithoracotomy to allow direct visualization and
Comment
The usefulness of VATS in the surgical treatment of spontaneous pneumothorax remains controversial. Although some centers recommend VATS as the approach of choice 2, 5, 7, 8, others report high recurrence and complication rates and recommend more caution 9, 10.
Many surgical techniques have been described for closing air leaks and performing pleurodesis. In some centers, the fistula almost always is closed by wedge resection using an endoscopic stapler, whereas in others, the endoscopic loop
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