Video-assisted thoracoscopic management of primary spontaneous pneumothorax

Although video-assisted thoracoscopic surgery (VATS) is now accepted by many as the approach of choice in the management of primary spontaneous pneumothorax (PSP), the optimal procedure and timing of surgical intervention remain as areas of contention. The author reviewed his personal experience with 224 consecutive VATS procedures for PSP. Mechanical pleurodesis was performed in every case and was the only procedure in 20 patients. We had experienced with several means of eliminating subpleural bullae once identified: stapled bullectomy (151), endoloop (12), argon beam coagulation (6) and endoscopic suturing (35). There were no mortality or intraoperative complications. The median postoperative hospital stay was 3 days. So far, we have had 4 recurrences (1.8%) after a mean follow-up of 20 months (range 1 to 36 months). Complications consisted of 10 persistent air leaks, 1 wound complication, and 1 chest wall bleeding. We conclude that 1) VATS is a safe and effective approach in the treatment of PSP; 2) Stapled-bullectomy is quick and reliable but costly; 3) Endoloop and suturing are viable alternative techniques that may prove to be more cost effective; and 4) we do not recommend the use of argon beam coagulation as the primary treatment modality.