Thoracotomy versus VATS: is there an optimal approach to treating pneumothorax?

Abstract

Introduction: The 2010 British Thoracic Society guidelines recommend that a weighted decision be made by clinicians with regard to surgical intervention for pneumothorax as the video assisted thoracoscopic surgery (VATS) approach is better tolerated by patients but carries a higher rate of recurrence (5% vs 1%).

Methods: Overall, 163 patients underwent surgical intervention for pneumothorax at our institution and data were collected prospectively for almost 7 years. Of these, 86 patients underwent VATS under a single surgeon with extensive VATS experience to compensate for the associated learning curve while 79 patients underwent an open procedure.

Results: There was no statistically significant difference in the recurrence rate between the open and the VATS group (1% vs 3.5%, p=1.0). The VATS group was superior to the open group in terms of reduced postoperative bleeding (7.5% vs 0%, p=0.01), reduced number of intensive care unit admissions (16% vs 0%, p<0.01) and a reduced adjusted length of stay (3 vs 5.5 days, p<0.01).

Conclusions: A comparable recurrence rate is attainable with a VATS approach once the learning curve is surpassed and a reduction in morbidity is an additional merit.

Figure 1

Box-and-whisker plot comparing the adjusted length of stay for both the video-assisted thoracoscopic surgery (VATS) and open group. Interquartile range depicted in box with median represented by horizontal line. Sample range depicted above and below.