Transaxillary minithoracotomy versus video-assisted thoracic surgery for spontaneous pneumothorax

Area of Science:

• Thoracic Surgery
• Minimally Invasive Surgery
• Pulmonology

Background:

• Video-assisted thoracic surgery (VATS) generally offers superior outcomes for spontaneous pneumothorax compared to thoracotomy.
• Transaxillary minithoracotomy (TAMT) has also demonstrated positive clinical results in managing spontaneous pneumothorax.

Purpose of the Study:

• To compare the clinical outcomes of VATS and TAMT in patients with spontaneous pneumothorax.
• To evaluate operative time, postoperative pain, chest tube duration, and recurrence rates between VATS and TAMT.

Main Methods:

• A comparative study involving 66 patients (13-81 years) with recurrent, persistent, or contralateral spontaneous pneumothorax.
• 36 patients underwent VATS, and 30 patients underwent TAMT.
• Key outcome measures included operative time, analgesic use, chest tube duration, and recurrence rates over a 6-24 month follow-up.

Main Results:

• No significant differences were observed in operative time (VATS: 91.2 ± 36.8 min vs. TAMT: 86.3 ± 40.9 min; p=0.6061).
• Analgesic use (VATS: 1.9 ± 2.3 ampules vs. TAMT: 2.1 ± 2.9 ampules; p=0.0883) and chest tube duration (VATS: 5.0 ± 4.0 days vs. TAMT: 4.3 ± 2.1 days; p=0.3707) were similar between groups.
• A notable finding was 4 recurrences in the VATS group versus none in the TAMT group.

Conclusions:

• VATS did not demonstrate advantages over TAMT for spontaneous pneumothorax management regarding operative time, postoperative pain, or chest tube duration.
• TAMT showed a lower recurrence rate compared to VATS in patients with apical bullae, suggesting its potential efficacy.
• TAMT may be a viable alternative to VATS for specific patient populations with spontaneous pneumothorax.