Videothoracoscopic treatment of spontaneous pneumothorax

Thoracoscopic surgery has been well accepted as a treatment for spontaneous pneumothorax and other intrathoracic diseases. Seventy-four patients with primary or secondary pneumothorax underwent thoracoscopic operation in this hospital. There was no postoperative mortality or major morbidity. Only two (2.7%) patients developed recurrent pneumothorax postoperatively, but this never reappeared after using bullae resection and mechanical pleurodesis in place of electroablation only at an earlier period. Three patients had residual pleural effusion or air space, and two patients had persistent air-leak postoperatively; all of them recovered after conservative treatment. The mean operation time, intensive care unit stay, and total hospital stay were decreased significantly when compared with open thoracotomy. The low recurrence rate and shorter hospital stay also made this procedure much superior to tube thoracostomy and chemical pleurodesis only. Approaches to make working ports, bullectomy, and pleurodesis are also discussed here. We concluded that thoracoscopic surgery is highly effective and minimally invasive for patients with spontaneous pneumothorax, but may not be suitable for patients with generalized emphysematous change of lungs or dense adhesion of the pleural spaces.