Video-assisted thoracoscopic surgery does not deteriorate postoperative pulmonary gas exchange in spontaneous pneumothorax patients.
OBJECTIVE
Video-assisted thoracoscopic surgery (VATS) is generally recognized as a less invasive method than thoracotomy. However, the influence of VATS on postoperative pulmonary gas exchange has yet to be evaluated.


METHODS
Thirty eight patients with spontaneous pneumothorax were randomized into bullectomy by VATS (n = 20) or axillary thoracotomy (n = 18). Gas exchange was assessed by using hot wire mass spectrometer, and blood gas analysis preoperatively and postoperatively at 1, 3, 6, 12, 24, and 48 h and on days 4 and 6. Post operative pain control was managed by continuous epidural morphine injection and administration of diclofenac sodium orally or suppository. Postoperative atelectasis was assessed by daily chest roentgenograms.


RESULTS
VATS patients had continuously higher PaO2 than axillary thoracotomy at 12, 48 h and day 4 postoperatively (P < 0.05). Alveolar-arterial oxygen tension gradient in VATS patients was significantly less than that in patients with axillary thoracotomy from the 6th h throughout to the 4th day postoperatively (P < 0.01). Use of postoperative analgesics and the incidence of peripheral atelectasis were more frequent in patients with axillary thoracotomy.


CONCLUSIONS
Bullectomy via VATS was less deleterious to pulmonary gas exchange. Axillary thoracotomy caused worsening of gas exchange postoperatively due to incisional pain, chest wall deformity, and peripheral atelectasis.
Sekine
Y
Y
Department of Surgery, Institute of Pulmonary Cancer Research, Chiba University School of Medicine, Japan. eysekine@aol.com
Miyata
Y
Y
Yamada
K
K
Yamada
H
H
Yasukawa
T
T
Saitoh
Y
Y
Yoshida
S
S
Fujisawa
T
T
D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011030:Pneumothorax / Q000503:physiopathology* / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology; D011184:Postoperative Period; D011659:Pulmonary Gas Exchange; D013906:Thoracoscopy; D014741:Video Recording