title: A modified two-port thoracoscopic technique versus axillary minithoracotomy for the treatment of recurrent spontaneous pneumothorax: a prospective randomized study.
abstract: BACKGROUND
  Currently, most thoracic surgeons perform surgical pleurodesis for recurrent spontaneous pneumothorax (RSP) by video-assisted thoracic surgery (VATS). However, the superiority of VATS over axillary minithoracotomy is not been established in prospective studies to date. A modified two-port VATS technique and axillary minithoracotomy were prospectively evaluated for possible differences in the short- and long-term outcome for patients.
  
  
  METHODS
  In this study, 66 consecutive patients underwent surgical pleurodesis for RSP through either a modified two-port VATS procedure (group A, 33 patients) or axillary minithoracotomy (group B, 33 patients). According to the study design (NCT01192217), the patients were randomly assigned to the two groups, which were similar in terms of age and body mass index. One-lung ventilation time, histology of the available lung parenchyma specimens, early postoperative complications, length of chest tube drainage and hospital stay, recurrence rate, and a score for patient satisfaction with treatment based on the sum of postoperative pain, dependent-arm mobilization, and return to full activity subscores were evaluated. The follow-up period varied from 3 to 53 months (median, 30 months).
  
  
  RESULTS
  The one-lung ventilation and operating times were significantly longer (p < 0.001) in group A than in group B. The overall detection of blebs, bulla, or both was 51.5% in group A and 63.8% in group B. The recurrence rate, complication rate, postoperative chest tube drainage duration, postoperative hospital stay, and incidence of chronic pain did not differ between the two groups. The score for patient satisfaction with treatment was significantly higher in group A than in group B (p < 0.001) according the subscores for better dependent-arm mobilization and return to full activity.
  
  
  CONCLUSIONS
  Axillary minithoracotomy and VATS are equally effective for the treatment of RSP, although the rate for resection of blebs, bulla, or both is higher with the axillary minithoracotomy procedure. Although VATS is more time consuming, it offers to the patient more satisfaction with treatment.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Aristotle University Medical School, AHEPA University Hospital, Stilponos Kiriakidi Street, 54636, Thessaloniki, Greece. cforoulis@otenet.gr
authors.forename: Christophoros N
authors.initials: CN
authors.lastname: Foroulis
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Anastasiadis
authors.forename: Nicholas
authors.initials: N
authors.lastname: Charokopos
authors.forename: Polychronis
authors.initials: P
authors.lastname: Antonitsis
authors.forename: Polychronis
authors.initials: P
authors.lastname: Antonitisis
authors.forename: Homerus V
authors.initials: HV
authors.lastname: Halvatzoulis
authors.forename: George T
authors.initials: GT
authors.lastname: Karapanagiotidis
authors.forename: Vassilis
authors.initials: V
authors.lastname: Grosomanidis
authors.forename: Christos
authors.initials: C
authors.lastname: Papakonstantinou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015505:Chest Tubes; D002648:Child; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011030:Pneumothorax / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012008:Recurrence; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D013906:Thoracoscopy / Q000379:methods*; D013908:Thoracotomy / Q000379:methods*; D055815:Young Adult