Article

Video assisted thoracic surgery for treatment of pneumothorax and lung resections: systematic review of randomised clinical trials

Health Services Research Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT.
BMJ (online) (Impact Factor: 16.38). 11/2004; 329(7473):1008. DOI: 10.1136/bmj.38243.440486.55
Source: PubMed

ABSTRACT To determine if video assisted thoracic surgery is associated with better clinical outcomes than thoracotomy for three common procedures: surgery for pneumothorax, minor resections, and lobectomy.
Systematic review of randomised clinical trials.
Medline, Embase, Cochrane database of systematic reviews, Cochrane controlled trials register. Reference lists of relevant articles and reviews.
Criteria for inclusion were random allocation of patients and no concurrent use of another experimental medication or device. At least two authors performed and confirmed data abstraction and analyses. Information on quality of trials, demographics, frequency of the events, and numbers randomised were collected.
12 trials randomised 670 patients. Video assisted thoracic surgery was associated with shorter length of stay (reduction ranged from 1.0 to 4.2 days) and less pain or use of pain medication than thoracotomy in the five out of seven trials in which the technique was used for pneumothorax or minor lung resection. In the treatment of pneumothorax, video assisted thoracic surgery was associated with substantially fewer recurrences than pleural drainage in two trials (from 20 to 53 events prevented per 100 treated patients). No substantial advantages were observed for video assisted thoracic surgery in lobectomies.
Video assisted thoracic surgery is associated with better outcomes and seems to have a complication profile comparable with that of thoracotomy for the treatment of pneumothorax and minor resections. As for lobectomy, further studies are needed to determine how it compares with thoracotomy.

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    • "reported a low recurrence rate (3.6%) during a mean 36.5 months follow-up period after VATS and none of them required re-operation. VATS bullae/blebectomy, pleurodesis, and pleurectomy have been proven to be as effective as the open procedure (Sedrakyan et al., 2004). However, re-operation following VATS is more often required than that after open thoracotomy (Tomasdottir et al., 2007), with a higher rate of both late recurrent pneumothoraces and prolonged early postoperative air-leakage. "
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    ABSTRACT: Primary spontaneous pneumothorax (PSP) commonly occurs in tall, thin, adolescent men. Though the pathogenesis of PSP has been gradually uncovered, there is still a lack of consensus in the diagnostic approach and treatment strategies for this disorder. Herein, the literature is reviewed concerning mechanisms and personal clinical experience with PSP. The chest computed tomography (CT) has been more commonly used than before to help understand the pathogenesis of PSP and plan further management strategies. The development of video-assisted thoracoscopic surgery (VATS) has changed the profiles of management strategies of PSP due to its minimal invasiveness and high effectiveness for patients with these diseases.
    Journal of Zhejiang University SCIENCE B 10/2010; 11(10):735-44. DOI:10.1631/jzus.B1000131 · 1.29 Impact Factor
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    • "The principles of surgical therapy in the case of primary spontaneous pneumothorax (PSP) are the resection of the pulmonary blebs and the obliteration of the pleural cavity; since its introduction in 1990, video-assisted thoracic surgery (VATS) has become, for most thoracic surgeons, the preferred surgical approach for PSP treatment [1] [2]. The VATS guided procedure to obtain the obliteration of the pleural cavity, however, is still widely varied in practice [3]; although good consensus has been achieved in considering parietal pleural abrasion the method of choice to induce pleurodesis, parietal pleurectomy, pleural talc poudrage, parietal pleural diathermy or laser coagulation are all still commonly used 4—7. "
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