Needlescopic video-assisted thoracic surgery for primary spontaneous pneumothorax.

Abstract

OBJECTIVES: Needlescopic Video-Assisted Thoracic Surgery (nVATS) uses smaller 3mm ports rather than the10mm ports used in conventional VATS (cVATS) to minimize surgical trauma. However, evidence for the role of nVATS in managing primary spontaneous pneumothorax (PSP) is limited. METHODS: Consecutive patients with PSP receiving VATS pleurodesis operations performed by a single surgeon during a 56 month period were identified. Patients with secondary pneumothorax, previous thoracic procedures and previous pleurodesis were excluded to maintain cohort homogeneity. All patients thus recruited received staple resection of lung blebs followed by abrasion pleurodesis to the entire parietal pleura. The nVATS approach was performed using two 3mm ports and the existing chest drain wound, whereas the cVATS approach employed conventional 10mm ports. The approach used depended solely on the availability of nVATS instruments at the time of operation. Clinical data from hospital records for all patients were supplemented with a telephone survey by an assessor blinded to the surgical approach used. RESULTS: During the study period, the nVATS approach was used to perform 67 pleurodesis procedures in 66 patients (55%), and the cVATS approach was used in 53 patients (45%). No mortality or major complications occurred in all patients. Patients in the two study arms were similar in all demographic and clinical parameters. After a median follow-up of 14 months, there were two recurrences (3.0%) in the nVATS group compared to four (7.5%) in the cVATS group (p=0.27). On Logrank testing, recurrence rates between the two groups were similar at up to 45 months (p=0.57). Other key results are displayed in the Table below. Patients in the nVATS group had lower mean pain scores immediately after surgery, shorter post-operative lengths of stay, shorter duration of requiring analgesics after surgery, and better satisfaction with the surgery. There were also trends for earlier return to full pre-operative work and for less residual paresthesia amongst patients receiving nVATS. CONCLUSIONS: In achieving surgical pleurodesis for PSP, the nVATS approach is as safe and effective as cVATS. However, nVATS may provide less pain, faster recovery, and greater patient acceptance. Further evaluation of nVATS for treating PSP is warranted.