Needlescopic video-assisted Thoracic Surgery for Primary Spontaneous Pneumothorax

Abstract

OBJECTIVE: Needlescopic Video-Assisted Thoracic Surgery (nVATS) uses smaller 3 mm ports rather than the 10 mm ports used in conventional VATS (cVATS) to minimize trauma in thoracic operations. The use of nVATS for managing Primary Spontaneous Pneumothorax (PSP) is a novel advance being developed in Hong Kong. METHODS: Consecutive patients with PSP receiving VATS pleurodesis operations performed by a single surgeon during a 5-year period (2007–2011) were identifi ed. Patients with secondary pneumothorax, previous thoracic procedures (including pleurodesis) were excluded. All patients received staple resection of lung blebs followed by abrasion pleurodesis to the entire parietal pleura, and all received identical peri-operative management. The nVATS approach was performed using only two 3 mm ports in addition to the existing chest drain wound, whereas the cVATS approach employed three conventional 10 mm ports. The approach used depended solely on the availability of nVATS instruments at the time of operation. RESULTS: During the study period, the nVATS approach was used for 68 pleurodesis procedures (53%), and the cVATS approach for 61 (47%). No mortality or major complications occurred in all patients. Patients in the two study arms were similar in all demographic and clinical parameters. On survival analysis, recurrence rates between the nVATS and cVATS groups were similar at up to 60 months (2.9% versus 8.2% respectively, p = 0.31). There was a strong trend for shorter mean length of hospital stay in the nVATS group (4.0 days versus 5.0 days, p = 0.07). Mean pain scores at rest and on movement were consistently lower in the nVATS group on each day during the postoperative stay, although the differences failed to reach statistical signifi cance. The mean time until patients resumed work was over 6 days shorter in the nVATS group, although again this failed to reach statistical signifi cance. On telephone interview, patients in the nVATS reported signifi cantly better mean scores for satisfaction with surgical wound cosmesis (6.4 versus 4.9, p < 0.01). CONCLUSIONS: To our knowledge, this is the largest study to date on the use of nVATS for the surgical treatment of PSP. Compared to conventional cVATS, the nVATS approach is equally safe and effective, and it may provide potentially less pain, faster recovery, and greater patient acceptance. Further evaluation of nVATS for treating PSP is warranted.