Video assisted thoracic surgery for treatment of pneumothorax and lung resections: systematic review of randomized clinical trials. BMJ 329(7473):1008

Health Services Research Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT.
BMJ (online) (Impact Factor: 17.45). 11/2004; 329(7473):1008. DOI: 10.1136/bmj.38243.440486.55
Source: PubMed


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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Available from: Jan van der Meulen, Jul 21, 2015
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    • "thoracoscopic procedures have been adopted. Meta-analyses comparing thoracotomy with video-assisted thoracoscopic surgery (VATS) procedures for treatment of pneumothorax have shown lower recurrence rates (1%) with open procedures [2] [3] but these are associated with greater blood loss, significantly greater postoperative pain and longer hospital stay [4]. Nowadays, VATS bullectomy and pleurodesis is widely accepted as a safe and reliable option for treatment of recurrent pneumothorax [1] [5] [6]. "
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    ABSTRACT: Over the past two decades, video-assisted thoracoscopic blebectomy and pleurodesis have been used as a safe and reliable option for treatment of spontaneous pneumothorax. The aim of this study is to evaluate the long-term outcome of video-assisted thoracoscopic surgery (VATS) treatment of spontaneous pneumothorax in young patients, and to identify risk factors for postoperative recurrence. We retrospectively analysed the outcome of VATS treatment of spontaneous pneumothorax in our institution in 150 consecutive young patients (age ≤40 years) in the years 1997-2010. Treatment consisted of stapling blebectomy and partial parietal pleurectomy. After excluding 16 patients lost to follow-up, in 134 cases [110 men, 24 women; mean age, 25 ± 7 standard deviation years; median follow-up, 79 months (range: 36-187 months)], we evaluated postoperative complications, focusing on pneumothorax recurrence, thoracic dysaesthesia and chronic chest pain. Risk factors for postoperative pneumothorax recurrence were analysed by logistic regression. Of 134 treated patients, 3 (2.2%) required early reoperation (2 for bleeding; 1 for persistent air leaks). Postoperative (90-day) mortality was nil. Ipsilateral pneumothorax recurred in 8 cases (6.0%) [median time of recurrence, 43 months (range: 1-71 months)]. At univariate analysis, the recurrence rate was significantly higher in women (4/24) than in men (4/110; P = 0.026) and in patients with >7-day postoperative air leaks (P = 0.021). Multivariate analysis confirmed that pneumothorax recurrence correlated independently with prolonged air leaks (P = 0.037) and with female gender (P = 0.045). Chronic chest wall dysaesthesia was reported by 13 patients (9.7%). In 3 patients, (2.2%) chronic thoracic pain (analogical score >4) was recorded, but only 1 patient required analgesics more than once a month. VATS blebectomy and parietal pleurectomy is a safe procedure for treatment of spontaneous pneumothorax in young patients, with a 6% long-term recurrence rate in our experience. Postoperative recurrence significantly correlates with female gender and with prolonged air leakage after surgery. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
    Interactive Cardiovascular and Thoracic Surgery 02/2015; 20(5). DOI:10.1093/icvts/ivv022 · 1.16 Impact Factor
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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 · 1.28 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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    ABSTRACT: The obliteration of pleural space is useful to prevent recurrences of spontaneous pneumothorax. We retrospectively compared the results of pleural argon beam coagulation versus pleural abrasion in the treatment of primary spontaneous pneumothorax. Between 1996 and 2004, 136 patients underwent surgery for primary spontaneous pneumothorax, with 143 surgical procedures, all performed by VATS. Indications were recurrent pneumothorax in 107 patients, a complicated first episode in 29 and occupational activity in 7. Six patients were excluded because of postoperative histopathological diagnosis other than pulmonary emphysema. In 70 cases pleurodesis was performed with argon beam coagulation and in 67 by Marlex degrees mesh abrasion. These techniques were employed during two different periods. Median follow-up was 68 months in the Marlex degrees group and 41 in the argon group. The two groups resulted as being homogeneous for gender, age, smoking attitude and surgical indication. Statistical analysis was done with chi2 and Fisher's test. No postoperative mortality was observed. Mean recovery time was 5 days. There were three patients with postoperative bleeding who underwent re-operation. There were nine cases of prolonged air-leak, one needing surgical exploration. Nine recurrences were noted, all requiring surgery. Two recurrences were observed in the group treated by pleural abrasion (3.4%) and seven in the group treated by argon coagulation (10.7%). The Fisher's test failed to demonstrate a statistical significance between the two procedures in terms of recurrence rate (p=0.18). Multivariate analysis yielded no risk factors for recurrences. Postoperative complications resulted as being equally distributed in both groups. After primary spontaneous pneumothorax, pleurodesis induced by argon beam parietal pleural coagulation resulted as being no better than that obtained by pleural abrasion in the prevention of recurrences. No benefits in terms of postoperative complications resulted by use argon beam coagulation.
    European Journal of Cardio-Thoracic Surgery 02/2006; 29(1):6-8. DOI:10.1016/j.ejcts.2005.10.034 · 3.30 Impact Factor
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