Does a thoracoscopic approach for surgical treatment of spontaneous pneumothorax represent progress?

Surgical management is indicated in recurrent forms of pneumothorax and for failure of tube drainage. We have for several years performed pleurodesis and apical blebs stapling by axillary thoracotomy. Thoracoscopy has been a well established procedure for 70 years and recently further developed as the result of current technological progress. For 10 years thoracoscopy has been developed as an alternative to thoracotomy in several indications. Spontaneous pneumothorax is ideally suitable for thoracoscopic management. The aim of this retrospective study is to evaluate this new approach.

We compare our results of axillary thoracotomy management of spontaneous pneumothorax in 237 patients (group 1) with those of thoracoscopic management in 101 patients (group 2). Sex distribution, average age, indications and stapling of apical blebs were comparable in both groups.

Etiologies were comparable in both groups. The average operation time was 71 min in group 1 and 57 min in group 2. The average duration of chest tube placement was 8 days in group 1 and 6.5 days in group 2. The mean hospital stay was 14 days in group 1 and 9.5 days in group 2. The overall morbidity was 16 and 11% in groups 1 and 2, respectively. The most frequent complication was early or late failure of pleurodesis which required second drainage or a subsequent operation. Late failure occurred more frequently after thoracoscopy (3 vs. 0.4%) but there was no statistically significant difference between the two groups.

Thoracoscopic management of spontaneous pneumothorax is a safe procedure. Moreover, it offers the benefits of a shorter hospital stay and less postoperative pain.