title: Video-assisted thoracic surgery: primary therapy for spontaneous pneumothorax?
abstract: BACKGROUND
  This study assessed the role of video-assisted thoracic surgery (VATS) in current therapy for spontaneous pneumothorax.
  
  
  METHODS
  We compared a retrospective series of 89 patients treated conventionally with a consecutive group of 30 patients undergoing VATS pleural abrasion. The 89 earlier patients were predominantly male (81%). Treatment groups included observation/aspiration (7 or 17%), tube thoracostomy (32 or 36%), multiple tubes (7 or 9%), and thoracotomy (43 or 48%). Of the 30 patients treated with VATS, 18 (66%) were male. Primary indications for operation were recurrent pneumothorax (17) and persistent air leak (9).
  
  
  RESULTS
  Hospital lengths of stay (LOS) for the earlier group were 5 days for simple tube and 7 days for primary thoracotomy; LOS for initial intervention followed by thoractomy exceeded 15 days in all subgroups. The average LOS in the VATS group was 13 days; 6 patients treated with primary VATS (no chest tube) had a mean LOS of 6.5 days. Complications included 3 (10%) prolonged air leaks (more than 7 days) and 2 (7%) early recurrences.
  
  
  CONCLUSIONS
  We do not recommend VATS as primary therapy for spontaneous pneumothorax; tube thoracostomy remains the treatment of choice. However, we strongly support surgical intervention early (3 days) in patients with a persistent air leak, and as primary therapy in a nonurgent situation if standard indications exist. This study shows no advantage of VATS over conventional thoracotomy in hospital stay or complication rate.
authors.affiliation: Section of Thoracic Surgery, University of Tennessee Center for the Health Sciences, Memphis, USA.
authors.forename: F H
authors.initials: FH
authors.lastname: Cole
authors.forename: F H
authors.initials: FH
authors.lastname: Cole
authors.forename: A
authors.initials: A
authors.lastname: Khandekar
authors.forename: J M
authors.initials: JM
authors.lastname: Maxwell
authors.forename: J W
authors.initials: JW
authors.lastname: Pate
authors.forename: W A
authors.initials: WA
authors.lastname: Walker
mesh_terms: D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D013907:Thoracostomy; D013908:Thoracotomy; D016896:Treatment Outcome; D014741:Video Recording