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Janssen N, Franssen AJPM, Ramos González AA, Laven IEWG, Jansen YJL, Daemen JHT, Lozekoot PWJ, Hulsewé KWE, Vissers YLJ, de Loos ER. Uniportal versus multiportal video-assisted thoracoscopic surgery for spontaneous pneumothorax. J Cardiothorac Surg 2024; 19:387. [PMID: 38926766 PMCID: PMC11201089 DOI: 10.1186/s13019-024-02931-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Multiportal video-assisted thoracic surgery (mVATS) is the standard approach for the surgical treatment of spontaneous pneumothorax. However, uniportal VATS (uVATS) has emerged as an alternative aiming to minimize surgical morbidity. This study aims to strengthen the evidence on the safety and efficiency of uVATS compared to mVATS. METHODS From January 2004 to December 2020, records of patients who had undergone surgical treatment for primary or secondary spontaneous pneumothorax were evaluated for eligibility. Patients who had undergone pleurectomy combined with bullectomy or apical wedge resection via uVATS or mVATS were included. Surgical characteristics and postoperative data were compared between patients who had undergone surgery via uVATS or mVATS. Univariable and multivariable analyses were performed to determine whether the surgical approach was associated with any complication (primary outcome), major complications (i.e., Clavien-Dindo ≥ 3), recurrence, prolonged hospitalization or prolonged chest drainage duration (secondary outcomes). RESULTS A total of 212 patients were enrolled. Patients treated via uVATS (n = 71) and mVATS (n = 141) were significantly different in pneumothorax type (secondary spontaneous; uVATS: 54 [76%], mVATS: 79 [56%]; p = 0.004). No significant differences were observed in (major) complications and recurrence rates between both groups. Multivariable analyses revealed that the surgical approach was no significant predictor for the primary or secondary outcomes. CONCLUSIONS This study indicates that uVATS is non-inferior to mVATS in the surgical treatment of spontaneous pneumothorax regarding safety and efficiency, and thus the uVATS approach has the potential for further improvements in the perioperative surgical care for spontaneous pneumothorax.
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Affiliation(s)
- Nicky Janssen
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands
| | - Aimée J P M Franssen
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands
| | - Arlette A Ramos González
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands
| | - Iris E W G Laven
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands
| | - Yanina J L Jansen
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands
| | - Jean H T Daemen
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands
| | - Pieter W J Lozekoot
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands
| | - Karel W E Hulsewé
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands
| | - Yvonne L J Vissers
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands
| | - Erik R de Loos
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, Heerlen, 6419PC, The Netherlands.
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Shanthanna H, Turan A, Vincent J, Saab R, Shargall Y, O'Hare T, Davis K, Fonguh S, Balasubramaniam K, Paul J, Gilron I, Kehlet H, Sessler DI, Bhandari M, Thabane L, Devereaux PJ. N-Methyl-D-Aspartate Antagonists and Steroids for the Prevention of Persisting Post-Surgical Pain After Thoracoscopic Surgeries: A Randomized Controlled, Factorial Design, International, Multicenter Pilot Trial. J Pain Res 2020; 13:377-387. [PMID: 32104059 PMCID: PMC7024793 DOI: 10.2147/jpr.s237058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 01/28/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose We conducted a feasibility 2×2 factorial trial comparing N-methyl-D-aspartate (NMDA) antagonists (intravenous ketamine and oral memantine) versus placebo and intravenous steroids versus placebo, in patients having elective video-assisted thoracic surgery lobectomies, at St. Joseph's Hamilton, Canada, and Cleveland Clinic, Cleveland, USA. Our feasibility objectives were: 1) recruitment rate/week; 2) recruitment of ≥90% of eligible patients; and 3) >90% follow-up. Secondary objectives were incidence and intensity of persistent post-surgical pain (PPSP) and other clinical and safety outcomes. Methods Using computerized randomization, patients were allocated to one of four groups: NMDA active with steroid placebo; NMDA placebo with steroid active; both NMDA and steroid active; both NMDA and steroid placebo. Patients, health providers, and data analysts were blinded to allocation. Patients were followed for 3 months after randomization. Results The trial was initiated in May 2017 at Hamilton and, after subsequent regulatory and ethics approval, in April 2018 at Cleveland. The trial had to be stopped after only 1 month of recruitment in Cleveland because the packaged study medications (memantine) expired and we were unable to procure the dosage required. Among 41 eligible patients, 27 (66%) were randomized. The recruitment rate/week was 0.63, 95% confidence interval (CI): 0.47-0.79 in Hamilton; and 1, 95% CI: 0.83-1.17 in Cleveland. Follow-up was complete for all 24 patients (100%) in Hamilton, and 3 of 4 patients in Cleveland. In total, only 4 patients (15%), and 2 patients (7%) had persistent pain at rest and with movement, respectively. There were no significant differences between groups for other outcomes. Conclusion The trial had to be stopped prematurely due to non-availability of study medications. Trial feasibility objectives of recruiting 90% of eligible patients and recruiting at least one patient/week per site were not met. Consideration for protocol changes will be necessary for the full trial. Trial Registration NCT02950233.
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Affiliation(s)
| | - Alparslan Turan
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Remie Saab
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yaron Shargall
- Department of Surgery, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Turlough O'Hare
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Kimberly Davis
- Acute Pain Service, St. Joseph Healthcare Hamilton, Hamilton, ON, Canada
| | | | | | - James Paul
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Ian Gilron
- Departments of Anesthesiology and Perioperative Medicine, Biomedical and Molecular Sciences, Centre for Neuroscience Studies and School of Policy Studies, Queen's University, Kingston, ON, Canada
| | - Henrik Kehlet
- Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen, Denmark
| | - Daniel I Sessler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - P J Devereaux
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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Vuong NL, Elshafay A, Thao LP, Abdalla AR, Mohyeldin IA, Elsabaa K, Omran ES, Yu F, Hirayama K, Huy NT. Efficacy of treatments in primary spontaneous pneumothorax: A systematic review and network meta-analysis of randomized clinical trials. Respir Med 2018; 137:152-166. [PMID: 29605200 DOI: 10.1016/j.rmed.2018.03.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 02/03/2018] [Accepted: 03/05/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Primary spontaneous pneumothorax (PSP) remains a significant global health problem. Despite general agreement, an official algorithm for the management of PSP still does not exist. OBJECTIVES Evaluating the efficacy of all available treatments in PSP. METHODS A systematic search of 12 electronic databases was performed to identify all randomized controlled trials (RCTs) of any treatments in PSP. The primary endpoint was recurrence incidence; secondary were an immediate success, complication and hospitalization days. All available outcomes were included in frequentist network meta-analysis. RESULTS 4262 patients of 29 RCTs were included. In patients with first episode of PSP, video-assisted thoracoscopic surgery (VATS), tube drainage and aspiration had no significant difference regarding recurrence. Chemical pleurodesis significantly reduced the recurrent incidence of 46% compared with aspiration and 54% compared with tube drainage. VATS and aspiration significantly decreased hospitalization days compared with tube drainage. In patients with recurrent or persistent PSP, thoracotomy with mechanical pleurodesis has a higher rank than VATS with or without pleurodesis in preventing recurrence, with no significant difference. VATS alone significantly reduced complications compared with all others treatments, except thoracotomy with abrasion. CONCLUSIONS Aspiration and tube drainage have no significant difference in treating patients with first episode of PSP regarding recurrence. Aspiration reduced hospitalization days when compared with tube drainage. Thoracotomy with mechanical pleurodesis and VATS with or without pleurodesis are not significantly different in preventing recurrence in patients with recurrent or persistent PSP. VATS alone reduced complications compared with others treatments except for thoracotomy with abrasion.
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Affiliation(s)
- Nguyen Lam Vuong
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, 70000, Viet Nam; Department of Medical Statistic and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, 70000, Viet Nam.
| | | | - Le Phuong Thao
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, 70000, Viet Nam.
| | | | | | - Khaled Elsabaa
- Faculty of Medicine, Al-Azhar University, Cairo, 11884, Egypt.
| | - Esraa Salah Omran
- Kasr Al-Aini School of Medicine, Cairo University, Cairo, 44523, Egypt.
| | - Fuxun Yu
- Guizhou Provincial People's Hospital, Guiyang, China.
| | - Kenji Hirayama
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan.
| | - Nguyen Tien Huy
- Evidence Based Medicine Research Group & Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, Viet Nam; Department of Clinical Product Development, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
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Aguinagalde B, Aranda JL, Busca P, Martínez I, Royo I, Zabaleta J. SECT Clinical practice guideline on the management of patients with spontaneous pneumothorax. Cir Esp 2017; 96:3-11. [PMID: 29248330 DOI: 10.1016/j.ciresp.2017.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 09/13/2017] [Accepted: 11/06/2017] [Indexed: 11/16/2022]
Abstract
This clinical practice guideline (CPG) emerges as an initiative of the scientific committee of the Spanish Society of Thoracic Surgery. We formulated PICO (patient, intervention, comparison, and outcome) questions on various aspects of spontaneous pneumothorax. For the evaluation of the quality of evidence and preparation of recommendations we followed the guidelines of the Grading of recommendations, Assessment, Development and Evaluation (GRADE) working group.
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Affiliation(s)
- Borja Aguinagalde
- Hospital Universitario Donostia, Donostia-San Sebastián, Guipúzcoa, España.
| | | | - Pablo Busca
- Hospital Universitario Donostia, Donostia-San Sebastián, Guipúzcoa, España
| | - Ivan Martínez
- Hospital Universitario 12 de Octubre, Madrid, España
| | - Iñigo Royo
- Hospital Universitario Miguel Servet, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Jon Zabaleta
- Hospital Universitario Donostia, Donostia-San Sebastián, Guipúzcoa, España
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Masmoudi H, Etienne H, Sylvestre R, Evrard D, Ouede R, Le Roux M, Giol M, Assouad J. Three Hundred Fifty-One Patients With Pneumothorax Undergoing Uniportal (Single Port) Video-Assisted Thoracic Surgery. Ann Thorac Surg 2017; 104:254-260. [PMID: 28410634 DOI: 10.1016/j.athoracsur.2017.01.054] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 01/01/2017] [Accepted: 01/11/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Video-assisted thoracic surgery (VATS) is usually performed using three ports. Uniportal VATS has not yet been widely developed. We report our single institution experience in uniportal VATS for the surgical management of 351 patients with pneumothorax. METHODS Between November 2009 and February 2016, we conducted a study in 351 patients treated for pneumothorax using uniportal VATS. Resection of apical bullae associated with partial pleurectomy, pleural abrasion, or talc effusion was performed. RESULTS The mean age was 29.6 ± 10.1 years. Surgical indications were mainly persistence or recurrence of pneumothorax. Sixty-seven patients (19%) presented with complications. At the 30-day control, 60.1% of patients were asymptomatic; 85% of patients were satisfied with the single small scar. The recurrence rate was 3.6% at 24 ± 13 months. CONCLUSIONS Uniportal VATS is feasible, safe, and reproducible in the treatment of pneumothorax. Morbidity is similar to multiport VATS. The recurrence rate is comparable with best results after multiport VATS or thoracotomy. Patients were satisfied with the single small scar.
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Affiliation(s)
- Hicham Masmoudi
- Department of Thoracic Surgery, Tenon Hospital, Paris, France.
| | - Harry Etienne
- Department of Thoracic Surgery, Tenon Hospital, Paris, France
| | | | - Diane Evrard
- Department of Thoracic Surgery, Tenon Hospital, Paris, France
| | - Raphaël Ouede
- Department of Thoracic Surgery, Tenon Hospital, Paris, France
| | | | - Mihaela Giol
- Department of Thoracic Surgery, Tenon Hospital, Paris, France
| | - Jalal Assouad
- Department of Thoracic Surgery, Tenon Hospital, Paris, France
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Zhang D, Miao J, Hu X, Hu B, Li H. A clinical study of efficacy of polyglycolic acid sleeve after video-assisted thoracoscopic bullectomy for primary spontaneous pneumothorax. J Thorac Dis 2017; 9:1093-1099. [PMID: 28523164 DOI: 10.21037/jtd.2017.03.109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Primary spontaneous pneumothorax (PSP) is a common disease in thoracic surgery, and a prolonged postoperative air leakage is the most frequent and troublesome early complication after video-assisted thoracoscopic (VATS) bullectomy. This study aimed to explore the efficacy of polyglycolic acid (PGA) sleeve in preventing postoperative air leakage after a VATS bullectomy for PSP. METHODS This study was a prospectively randomised clinical study. The patients who underwent a VATS bullectomy were continuously enrolled from January 2015 to June 2016 in the Beijing Chaoyang Hospital and were randomly assigned to the experimental and control groups. The experimental group applied a PGA sleeve combined with an automatic stapler in the bullectomy, while in the control group, the bullae were resected using an automatic stapler alone during the operation. In addition, the staple lines in both groups were covered with an absorbable polyglycolic acid sheet and both groups performed pleural abrasion after the resection. Useful clinical data were recorded, including the number of cases there was no air leakage immediately after the operation and air leakage lasted more than 3 days, the average postoperative air leakage, the drainage tube removal time, the postoperative hospital stay, the postoperative complications, and the postoperative recurrence. RESULTS A total of 134 patients were enrolled in this study. The experimental group consisted of 60 subjects, and there were 74 in the control group. No operative related mortality was observed in either group. In the experimental group, 44 of the 60 patients did not have an air leakage immediately after the operation, which was significantly higher than the control group (73.33% vs. 54.05%, P=0.031). Compared with the control group, the average postoperative air leakage (0.57±1.11 days), the chest tube removal time (3.03±0.92 days), and the postoperative hospital stay (3.98±0.92 days) were all significantly shorter in the experimental group (P=0.048, P=0.012, and P=0.010, respectively). Moreover, the rate of postoperative complications in the experimental group was lower than the control group (3.33% vs. 16.22%, P=0.021). No postoperative recurrence was observed in either group during the follow-up period that ranged from 8 to 25 months. CONCLUSIONS The use of PGA sleeve during surgery for PSP might effectively prevent early postoperative air leakage, as well as reduce the postoperative drainage tube removal time and the postoperative hospital stay.
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Affiliation(s)
- Duo Zhang
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Jinbai Miao
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Xiaoxing Hu
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Bin Hu
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
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Dżeljilji A, Rokicki W, Rokicki M, Karuś K. New aspects in the diagnosis and treatment of primary spontaneous pneumothorax. KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA = POLISH JOURNAL OF CARDIO-THORACIC SURGERY 2017; 14:27-31. [PMID: 28515745 PMCID: PMC5404124 DOI: 10.5114/kitp.2017.66926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 10/14/2016] [Indexed: 11/26/2022]
Abstract
This paper provides a recapitulation of the position of the British Thoracic Society and the American College of Chest Physicians based on a review of the literature concerning the current methods of diagnosing and treating primary spontaneous pneumothorax (PSP). The previously developed guidelines were re-evaluated in 2015 by a task force of the European Respiratory Society (ERS). They are intended to be used by surgeons as well as emergency and pulmonary ward physicians, and they apply largely to emergency procedures. In recent years, the effectiveness of minimally invasive methods (punctures, drainage) in combination with talc pleurodesis for the initial therapy of PSP has been recognized. The efficacy of thoracoscopy (VATS) for the treatment of this disease has been proven by the development of minimally invasive surgical techniques in thoracic surgery. This paper also discusses the efficacy of the surgical methods available.
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Affiliation(s)
- Agata Dżeljilji
- Department of Surgery, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Wojciech Rokicki
- Department of Thoracic Surgery in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Marek Rokicki
- Department of Thoracic Surgery in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Krzysztof Karuś
- Center of Pulmonology and Thoracic Surgery, Bystra Śląska, Poland
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Cardillo G, Bintcliffe OJ, Carleo F, Carbone L, Di Martino M, Kahan BC, Maskell NA. Primary spontaneous pneumothorax: a cohort study of VATS with talc poudrage. Thorax 2016; 71:847-53. [PMID: 27422793 DOI: 10.1136/thoraxjnl-2015-207976] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/05/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Video-assisted thoracoscopic surgery (VATS) is an increasingly common treatment for recurrent or persistent primary spontaneous pneumothorax (PSP). Surgery usually involves diffuse treatment of the pleura and possible targeted therapy to areas of bullous disease. The purpose of this large cohort study was to examine incidence of recurrence after VATS and identify predictors of outcome. METHODS Patients undergoing VATS for PSP at a single centre between 2000 and 2012 were prospectively enrolled. All patients underwent talc poudrage. Targeted surgical techniques were used based on presence of air leak and Vanderschueren's stage. Patients had clinical and radiological follow-up for at least 2 years (median 8.5 years). RESULTS 1415 patients with PSP underwent VATS with talc poudrage. The most frequent indications were recurrent pneumothorax (92.2%) and persistent air leak (6.5%). The complication rate was 2.0% of which 1.7% was prolonged air leak. There was no mortality. Median length of stay was 5 days. Recurrent pneumothorax occurred in 26 patients (1.9%). At the time of surgery, 592 patients smoked (43%) and they had a significantly higher incidence of recurrence (24/575, 4.2%) than non-smokers (2/805, 0.2%), p<0.001. The incidence of recurrence in those undergoing bullae suturing (3.8%, n=260) was significant higher than those undergoing poudrage alone (0.3%, p=0.036). CONCLUSION The marked difference in recurrence between smokers and non-smokers suggests this as an important predictor of outcome. This study demonstrates a low incidence of recurrence and complications for patients with PSP undergoing VATS with talc poudrage. Talc poudrage requires prospective comparison with pleurectomy and mechanical abrasion.
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Affiliation(s)
- Giuseppe Cardillo
- Unit of Thoracic Surgery, L. Spallanzani Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Oliver J Bintcliffe
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Francesco Carleo
- Unit of Thoracic Surgery, L. Spallanzani Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Luigi Carbone
- Unit of Thoracic Surgery, L. Spallanzani Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Marco Di Martino
- Unit of Thoracic Surgery, L. Spallanzani Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Brennan C Kahan
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Nick A Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
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Vats Versus Axillary Minithoracotomy in the Management of the Second Episode of Spontaneous Pneumothorax: Cost–Benefit Analysis. World J Surg 2016; 40:2171-7. [DOI: 10.1007/s00268-016-3558-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jeon HW, Kim YD, Kye YK, Kim KS. Air leakage on the postoperative day: powerful factor of postoperative recurrence after thoracoscopic bullectomy. J Thorac Dis 2016; 8:93-7. [PMID: 26904217 DOI: 10.3978/j.issn.2072-1439.2016.01.38] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Primary spontaneous pneumothorax (PSP) is a relatively common disorder in young patients. Although various surgical techniques have been introduced, recurrence after video-assisted thoracoscopic surgery (VATS) remains high. The aim of study was to identify the risk factors for postoperative recurrence after thoracoscopic bullectomy in the spontaneous pneumothorax. METHODS From January 2011 through March 2013, two hundreds and thirty two patients underwent surgery because of pneumothorax. Patients with a secondary pneumothorax, as well as cases of single port surgery, an open procedure, additional pleural procedure (pleurectomy, pleural abrasion) or lack of medical records were excluded. The records of 147 patients with PSP undergoing 3-port video-assisted thoracoscopic bullectomy with staple line coverage using an absorbable polyglycolic acid (PGA) sheet were retrospectively reviewed. RESULTS The median age was 19 years (range, 11-34 years) with male predominance (87.8%). Median postoperative hospital stay was 3 days (range, 1-10 days) without mortality. Complications were developed in five patients. A total of 24 patients showed postoperative recurrence (16.3%). Younger age less than 17 years old and immediate postoperative air leakage were risk factors for postoperative recurrence after thoracoscopic bullectomy by multivariate analysis. CONCLUSIONS Immediate postoperative air leakage was the risk factor for postoperative recurrence. However, further study will be required for the correlation of air leakage with recurrence.
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Affiliation(s)
- Hyun Woo Jeon
- 1 Department of Thoracic and Cardiovascular Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Du Kim
- 1 Department of Thoracic and Cardiovascular Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yeo Kon Kye
- 1 Department of Thoracic and Cardiovascular Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung Soo Kim
- 1 Department of Thoracic and Cardiovascular Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Ooi A, Ling Z. Uniportal video assisted thoracoscopic surgery bullectomy and double pleurodesis for primary spontaneous pneumothorax. J Vis Surg 2016; 2:17. [PMID: 29078445 DOI: 10.3978/j.issn.2221-2965.2016.01.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 12/27/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND Primary spontaneous pneumothorax (PSP) usually occurs in young adults, with higher incidence in smoker, and patients with narrow chest frame and slim body habitus. Surgery is indicated in the cases of recurrence episodes or persistent lung collapse, and failed conservative management by chest drain insertion. Video assisted thoracoscopic surgery (VATS) bullectomy and pleurodesis is the surgical treatment of choice but uniportal approach has been utilised to further minimise surgical trauma, improve cosmesis without compromising the efficacy of the procedure. METHODS This video demonstrated the uniportal procedure for bullectomy and double pleurodesis for PSP. A 2.5 cm incision was made at 4th intercostal space, anterior axillary line. Extra small size wound protector was used and CO2 insufflation was not needed. Adhesion divided with diathermy and visible apical bullae was resected using endoscopic stapler. Abrasive pleurodesis performed by using scratch patch mounted on Robert clamp, gently running along the parietal pleura within the chest wall. In addition, 5 grams of pure talc was delivered into pleural space. Single drain inserted via the port and lung fully inflated upon resuming ventilation by anaesthetist. Drain remained for 48 hours under negative pressure of -20 mmHg and patient usually went home on day 3 post-operatively. RESULTS During the period from 2009 to 2015, over 160 cases of PSP were treated using this method by the author. To date, there is no recurrence reported upon follow up at outpatient clinic. There was no mortality and patients resumed active physical activity 8 weeks after the procedure. CONCLUSIONS Uniportal VATS bullectomy and double pleurodesis is a safe procedure for treating PSP and effective in preventing future recurrence of lung collapse. This simple approach should be encouraged and performed by all enthusiastic VATS thoracic surgeons.
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Affiliation(s)
- Adrian Ooi
- Department of Cardiothoracic Surgery, Gleneagles Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Zhu Ling
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
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Hsu HH, Chen JS. The etiology and therapy of primary spontaneous pneumothoraces. Expert Rev Respir Med 2015; 9:655-65. [DOI: 10.1586/17476348.2015.1083427] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tschopp JM, Bintcliffe O, Astoul P, Canalis E, Driesen P, Janssen J, Krasnik M, Maskell N, Van Schil P, Tonia T, Waller DA, Marquette CH, Cardillo G. ERS task force statement: diagnosis and treatment of primary spontaneous pneumothorax. Eur Respir J 2015; 46:321-35. [PMID: 26113675 DOI: 10.1183/09031936.00219214] [Citation(s) in RCA: 203] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 03/17/2015] [Indexed: 12/15/2022]
Abstract
Primary spontaneous pneumothorax (PSP) affects young healthy people with a significant recurrence rate. Recent advances in treatment have been variably implemented in clinical practice. This statement reviews the latest developments and concepts to improve clinical management and stimulate further research.The European Respiratory Society's Scientific Committee established a multidisciplinary team of pulmonologists and surgeons to produce a comprehensive review of available scientific evidence.Smoking remains the main risk factor of PSP. Routine smoking cessation is advised. More prospective data are required to better define the PSP population and incidence of recurrence. In first episodes of PSP, treatment approach is driven by symptoms rather than PSP size. The role of bullae rupture as the cause of air leakage remains unclear, implying that any treatment of PSP recurrence includes pleurodesis. Talc poudrage pleurodesis by thoracoscopy is safe, provided calibrated talc is available. Video-assisted thoracic surgery is preferred to thoracotomy as a surgical approach.In first episodes of PSP, aspiration is required only in symptomatic patients. After a persistent or recurrent PSP, definitive treatment including pleurodesis is undertaken. Future randomised controlled trials comparing different strategies are required.
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Affiliation(s)
- Jean-Marie Tschopp
- Centre Valaisan de Pneumologie, Dept of Internal Medicine RSV, Montana, Switzerland Task Force Chairs
| | - Oliver Bintcliffe
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Philippe Astoul
- Dept of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hospital North Aix-Marseille University, Marseille, France
| | - Emilio Canalis
- Dept of Surgery, University of Rovira I Virgili, Tarragona, Spain
| | | | - Julius Janssen
- Dept of Pulmonary Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Marc Krasnik
- Dept of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Nicholas Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Paul Van Schil
- Dept of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Thomy Tonia
- Institute of Social and Preventative Medicine, University of Bern, Bern, Switzerland
| | - David A Waller
- Dept of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - Charles-Hugo Marquette
- Hospital Pasteur CHU Nice and Institute for Research on Cancer and Ageing, University of Nice Sophia Antipolis, Nice, France
| | - Giuseppe Cardillo
- Dept of Thoracic Surgery, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy Task Force Chairs
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Delpy JP, Pagès PB, Mordant P, Falcoz PE, Thomas P, Le Pimpec-Barthes F, Dahan M, Bernard A. Surgical management of spontaneous pneumothorax: are there any prognostic factors influencing postoperative complications? Eur J Cardiothorac Surg 2015; 49:862-7. [PMID: 26071433 DOI: 10.1093/ejcts/ezv195] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/04/2015] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES There are no guidelines regarding the surgical approach for spontaneous pneumothorax. It has been reported, however, that the risk of recurrence following video-assisted thoracic surgery is higher than that following open thoracotomy (OT). The objective of this study was to determine whether this higher risk of recurrence following video-assisted thoracic surgery could be attributable to differences in intraoperative parenchymal resection and the pleurodesis technique. METHODS Data for 7647 patients operated on for primary or secondary spontaneous pneumothorax between 1 January 2005 and 31 December 2012 were extracted from Epithor®, the French national database. The type of pleurodesis and parenchymal resection was collected. Outcomes were (i) bleeding, defined as postoperative pleural bleeding; (ii) pulmonary and pleural complications, defined as atelectasis, pneumonia, empyema, prolonged ventilation, acute respiratory distress syndrome and prolonged air leaks; (iii) in-hospital length of stay and (iv) recurrence, defined as chest drainage or surgery for a second pneumothorax. RESULTS Of note, 6643 patients underwent videothoracoscopy and 1004 patients underwent OT. When compared with the thoracotomy group, the videothoracoscopy group was associated with more parenchymal resections (62.4 vs 80%, P = 0.01), fewer mechanical pleurodesis procedures (93 vs 77.5%, P < 10(-3)), fewer postoperative respiratory complications (12 vs 8.2%, P = 0.01), fewer cases of postoperative pleural bleeding (2.3 vs 1.4%, P = 0.04) and shorter hospital lengths of stay (16 vs 9 days, P = 0.01). The recurrence rate was 1.8% (n = 18) in the thoracotomy group versus 3.8% (n = 254) in the videothoracoscopy group (P = 0.01). The median time between surgery and recurrence was 3 months (range: 1-76 months). CONCLUSIONS In the surgical management of spontaneous pneumothorax, videothoracoscopy is associated with a higher rate of recurrence than OT. This difference might be attributable to differences in the pleurodesis technique rather than differences in the parenchymal resection.
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Affiliation(s)
| | | | | | | | - Pascal Thomas
- CHU Marseille, North Hospital, Marseille Cedex, France
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The effect of pleural abrasion on the treatment of primary spontaneous pneumothorax: a systematic review of randomized controlled trials. PLoS One 2015; 10:e0127857. [PMID: 26042737 PMCID: PMC4456155 DOI: 10.1371/journal.pone.0127857] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 04/21/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pleural abrasion has been widely used to control the recurrence of primary spontaneous pneumothorax (PSP). However, controversy still exists regarding the advantages and disadvantages of pleural abrasion compared with other interventions in preventing the recurrence of PSP. METHODS The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched up to December 15, 2014 to identify randomized controlled trials (RCTs) that compared the effects of pleural abrasion with those of other interventions in the treatment of PSP. The study outcomes included the PSP recurrence rate and the occurrence rate of adverse effects. RESULTS Mechanical pleural abrasion and apical pleurectomy after thoracoscopic stapled bullectomy exhibited similarly persistent postoperative air leak occurrence rates (p = 0.978) and 1-year PSP recurrence rates (p = 0.821), whereas pleural abrasion led to reduced residual chest pain and discomfort (p = 0.001) and a smaller rate of hemothorax (p = 0.036) than did apical pleurectomy. However, the addition of minocycline pleurodesis to pleural abrasion did not reduce the pneumothorax recurrence rate compared with apical pleurectomy (3.8% for both procedures) but was associated with fewer complications. There was no statistical difference in the pneumothorax recurrence rate between mechanical pleural abrasion and chemical pleurodesis with minocycline on either an intention-to-treat basis (4 of 42 versus 0 of 42, p = 0.12; Fisher exact test) or after exclusions (2 of 40 versus 0 of 42, p = 0.24; Fisher exact test). Pleural abrasion plus minocycline pleurodesis also did not reduce the pneumothorax recurrence rate compared with pleural abrasion alone (p = 0.055). Moreover, pleural abrasion plus minocycline pleurodesis was associated with more intense acute chest pain. The postoperative overall recurrence rate in patients who underwent staple line coverage with absorbable cellulose mesh and fibrin glue was similar to that with mechanical abrasion after thoracoscopic bullectomy (13.8% vs. 14.2%, respectively; p = 0.555), but staple line coverage resulted in less postoperative residual pain than mechanical abrasion (0.4% vs.3.2%; p<0.0001). Pleural abrasion after thoracoscopic wedge resection did not decrease the recurrence of pneumothorax compared with wedge resection alone (p = 0.791), but the intraoperative bleeding and postoperative pleural drainage rates were higher when pleural abrasion was performed. CONCLUSIONS In addition to resulting in the same pneumothorax recurrence rate, thoracoscopic pleural abrasion with or without minocycline pleurodesis is safer than apical pleurectomy in the treatment of PSP. However, minocycline pleurodesis with or without pleural abrasion is not any more effective than pleural abrasion alone. Moreover, additional mechanical abrasion is not safer than additional staple line coverage with absorbable cellulose mesh and fibrin glue after thoracoscopic bullectomy because of increased postoperative pain. Additionally, pleural abrasion after thoracoscopic wedge resection should not be recommended for routine application due to the greater incidence of adverse effects than wedge resection alone. However, further large-scale, well-designed RCTs are needed to confirm the best procedure.
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Baltayiannis N, Michail C, Lazaridis G, Anagnostopoulos D, Baka S, Mpoukovinas I, Karavasilis V, Lampaki S, Papaiwannou A, Karavergou A, Kioumis I, Pitsiou G, Katsikogiannis N, Tsakiridis K, Rapti A, Trakada G, Zissimopoulos A, Zarogoulidis K, Zarogoulidis P. Minimally invasive procedures. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:55. [PMID: 25861610 DOI: 10.3978/j.issn.2305-5839.2015.03.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 01/28/2015] [Indexed: 12/16/2022]
Abstract
Minimally invasive procedures, which include laparoscopic surgery, use state-of-the-art technology to reduce the damage to human tissue when performing surgery. Minimally invasive procedures require small "ports" from which the surgeon inserts thin tubes called trocars. Carbon dioxide gas may be used to inflate the area, creating a space between the internal organs and the skin. Then a miniature camera (usually a laparoscope or endoscope) is placed through one of the trocars so the surgical team can view the procedure as a magnified image on video monitors in the operating room. Specialized equipment is inserted through the trocars based on the type of surgery. There are some advanced minimally invasive surgical procedures that can be performed almost exclusively through a single point of entry-meaning only one small incision, like the "uniport" video-assisted thoracoscopic surgery (VATS). Not only do these procedures usually provide equivalent outcomes to traditional "open" surgery (which sometimes require a large incision), but minimally invasive procedures (using small incisions) may offer significant benefits as well: (I) faster recovery; (II) the patient remains for less days hospitalized; (III) less scarring and (IV) less pain. In our current mini review we will present the minimally invasive procedures for thoracic surgery.
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Affiliation(s)
- Nikolaos Baltayiannis
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Chandrinos Michail
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - George Lazaridis
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Dimitrios Anagnostopoulos
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Sofia Baka
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Ioannis Mpoukovinas
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Vasilis Karavasilis
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Sofia Lampaki
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Antonis Papaiwannou
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Anastasia Karavergou
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Ioannis Kioumis
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Georgia Pitsiou
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Nikolaos Katsikogiannis
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Kosmas Tsakiridis
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Aggeliki Rapti
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Georgia Trakada
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Athanasios Zissimopoulos
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Konstantinos Zarogoulidis
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Paul Zarogoulidis
- 1 Consultant of Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 2 Department of Surgery, Metaxa Hospital, Piraeus, Greece ; 3 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 4 Thoracic Surgery Department, Metaxa Hospital, Piraeus, Greece ; 5 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 6 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 7 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 8 Surgery Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 9 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 10 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 11 Pulmonary Laboratory of Alexandra Hospital, University of Athens, Athens, Greece ; 12 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece
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Lazopoulos A, Barbetakis N, Lazaridis G, Baka S, Mpoukovinas I, Karavasilis V, Kioumis I, Pitsiou G, Papaiwannou A, Katsikogiannis N, Mpakas A, Tsakiridis K, Lampaki S, Karavergou A, Kipourou M, Lada M, Zarogoulidis K, Zarogoulidis P. Open thoracotomy for pneumothorax. J Thorac Dis 2015; 7:S50-5. [PMID: 25774309 DOI: 10.3978/j.issn.2072-1439.2015.01.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 01/08/2015] [Indexed: 11/14/2022]
Abstract
A thoracotomy is an incision into the pleural space of the chest. It is performed by surgeons (or emergency physicians under certain circumstances) to gain access to the thoracic organs, most commonly the heart, the lungs, or the esophagus, or for access to the thoracic aorta or the anterior spine. This surgical procedure is a major surgical maneuver it is the first step in many thoracic surgeries including lobectomy or pneumonectomy for lung cancer and as such requires general anesthesia with endotracheal tube insertion and mechanical ventilation, rigid bronchoscope can be also used if necessary. Thoracotomies are thought to be one of the most difficult surgical incisions to deal with post-operatively, because they are extremely painful and the pain can prevent the patient from breathing effectively, leading to atelectasis or pneumonia. In the current review we will present the steps of this procedure.
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Affiliation(s)
- Achilleas Lazopoulos
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Nikolaos Barbetakis
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - George Lazaridis
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Sofia Baka
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Ioannis Mpoukovinas
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Vasilis Karavasilis
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Ioannis Kioumis
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Georgia Pitsiou
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Antonis Papaiwannou
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Nikolaos Katsikogiannis
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Andreas Mpakas
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Kosmas Tsakiridis
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Sofia Lampaki
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Anastasia Karavergou
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Maria Kipourou
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Martha Lada
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Konstantinos Zarogoulidis
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
| | - Paul Zarogoulidis
- 1 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 4 Oncology Department, "BioMedicine" Private Clinic, Thessaloniki, Greece ; 5 Pulmonary-Oncology, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece
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Pagès PB, Delpy JP, Falcoz PE, Thomas PA, Filaire M, Le Pimpec Barthes F, Dahan M, Bernard A. Videothoracoscopy Versus Thoracotomy for the Treatment of Spontaneous Pneumothorax: A Propensity Score Analysis. Ann Thorac Surg 2015; 99:258-63. [DOI: 10.1016/j.athoracsur.2014.08.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 08/15/2014] [Accepted: 08/25/2014] [Indexed: 10/24/2022]
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Huang Y, Huang H, Li Q, Browning RF, Parrish S, Turner JF, Zarogoulidis K, Kougioumtzi I, Dryllis G, Kioumis I, Pitsiou G, Machairiotis N, Katsikogiannis N, Courcoutsakis N, Madesis A, Diplaris K, Karaiskos T, Zarogoulidis P. Approach of the treatment for pneumothorax. J Thorac Dis 2014; 6:S416-20. [PMID: 25337397 DOI: 10.3978/j.issn.2072-1439.2014.08.24] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 08/13/2014] [Indexed: 11/14/2022]
Abstract
Pneumothorax can occur in several situations such as; chronic obstructive pulmonary disease (COPD) where emphysema is observed or due to a biopsy for malignancy suspicion. In any case it is a dangerous situation that requires immediate attention and treatment. Pneumothorax can be divided in primary and secondary. Staging of pneumothorax is also very important. In our current editorial we summarize etiology and treatment of pneumothorax from a panel of pulmonary physicians, oncologists and thoracic surgeons.
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Affiliation(s)
- Yong Huang
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Haidong Huang
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Qiang Li
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Robert F Browning
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Scott Parrish
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - J Francis Turner
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Zarogoulidis
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioanna Kougioumtzi
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Dryllis
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kioumis
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Pitsiou
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Machairiotis
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Katsikogiannis
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Courcoutsakis
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Madesis
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Diplaris
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros Karaiskos
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paul Zarogoulidis
- 1 Respiratory Department, Chongqing Zhongshan Hospital, Chongqing 400013, China ; 2 Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai 200433, China ; 3 Walter Reed National Military Medical Center, Interventional Pulmonary, Bethesda, MD, USA ; 4 Cancer Treatment Centers of America, Interventional Pulmonary & Critical Care Medicine, Goodyear, AZ, USA ; 5 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 6 Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Hematology Department, "Laiko" University General Hospital, Athens, Greece ; 8 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, Athens, Greece ; 9 Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 10 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Goto T, Kadota Y, Mori T, Yamashita SI, Horio H, Nagayasu T, Iwasaki A. Video-assisted thoracic surgery for pneumothorax: republication of a systematic review and a proposal by the guideline committee of the Japanese association for chest surgery 2014. Gen Thorac Cardiovasc Surg 2014; 63:8-13. [PMID: 25182971 DOI: 10.1007/s11748-014-0468-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this consensus conference was to determine whether video-assisted thoracic surgery (VATS) improves clinical outcomes compared with conventional thoracotomy in patients undergoing surgery for pneumothorax, and to outline evidence-based recommendations for the use of VATS. METHODS Before the consensus conference, the best available evidence was reviewed, with systematic reviews, randomized trials, and nonrandomized trials all taken into consideration in descending order of validity and importance. At the consensus conference, evidence-based interpretative statements were created, and consensus processes were used to determine the ensuing recommendations. The Medical Information Network Distribution Service in Japan (Minds) system was used to label the levels of evidence for the references and the classes of recommendations. RESULTS AND RECOMMENDATIONS The consensus panel agreed upon the following statements and recommendations for patients with pneumothorax undergoing surgery: 1. VATS is broadly indicated as surgery for pneumothorax. 2. VATS is judged to be less invasive, as it results in minimal postoperative pain, the periods of chest tube placement and hospitalization are short, and it shows a trend toward early realization of social integration. 3. There is no difference in terms of safety and complications between VATS and open thoracotomy. 4. As it is anticipated that VATS will result in a higher recurrence rate than open thoracotomy, it may be desirable to add a supplemental procedure during surgery. In summary, VATS can be recommended as pneumothorax surgery (Recommendation grade: Level B).
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Affiliation(s)
- Taichiro Goto
- Guidelines Committees of Japanese Association for Chest Surgery, Kyoto, Japan,
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21
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Kang DK, Min HK, Jun HJ, Hwang YH, Kang MK. Early outcomes of single-port video-assisted thoracic surgery for primary spontaneous pneumothorax. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2014; 47:384-8. [PMID: 25207248 PMCID: PMC4157502 DOI: 10.5090/kjtcs.2014.47.4.384] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 11/23/2013] [Accepted: 11/24/2013] [Indexed: 11/16/2022]
Abstract
Background Recently, single-port video-assisted thoracic surgery (VATS) has been proposed as an alternative to the conventional three-port VATS for primary spontaneous pneumothorax (PSP). The aim of this study is to evaluate the early outcomes of the single-port VATS for PSP. Methods VATS was performed for PSP in 52 patients from March 2012 to March 2013. We reviewed the medical records of these 52 patients, retrospectively. Nineteen patients underwent the conventional three-port VATS (three-port group) and 33 patients underwent the single-port VATS (single-port group). Both groups were compared according to the operation time, number of wedge resections, amount of chest tube drainage during the first 24 hours after surgery, length of chest tube drainage, length of hospital stay, postoperative pain score, and postoperative paresthesia. Results There was no difference in patient characteristics between the two groups. There was no difference in the number of wedge resections, operation time, or amount of drainage between the two groups. The mean lengths of chest tube drainage and hospital stay were shorter in the single-port group than in the three-port group. Further, there was less postoperative pain and paresthesia in the single-port group than in the three-port group. These differences were statistically significant. The mean size of the surgical wound was 2.10 cm (range, 1.6 to 3.0 cm) in the single-port group. Conclusion Single-port VATS for PSP had many advantages in terms of the lengths of chest tube drainage and hospital stay, postoperative pain, and paresthesia. Single-port VATS is a feasible technique for PSP as an alternative to the conventional three-port VATS in well-selected patients.
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Affiliation(s)
- Do Kyun Kang
- Department of Thoracic and Cardiovascular Surgery, Inje University Haeundae Paik Hospital
| | - Ho Ki Min
- Department of Thoracic and Cardiovascular Surgery, Inje University Haeundae Paik Hospital
| | - Hee Jae Jun
- Department of Thoracic and Cardiovascular Surgery, Inje University Haeundae Paik Hospital
| | - Youn Ho Hwang
- Department of Thoracic and Cardiovascular Surgery, Inje University Haeundae Paik Hospital
| | - Min-Kyun Kang
- Inje University Busan Paik Hospital, Inje University College of Medicine
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22
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Bille A, Barker A, Maratos EC, Edmonds L, Lim E. Surgical access rather than method of pleurodesis (pleurectomy or pleural abrasion) influences recurrence rates for pneumothorax surgery: systematic review and meta-analysis. Gen Thorac Cardiovasc Surg 2012; 60:321-5. [DOI: 10.1007/s11748-012-0080-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 01/31/2012] [Indexed: 11/30/2022]
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23
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Szentkereszty Z, Csiszkó A, Boros M, Veres L, Sz Kiss S. [The treatment of spontaneous pneumothorax--focusing on the use of videothoracoscopy]. Magy Seb 2010; 63:112-7. [PMID: 20570783 DOI: 10.1556/maseb.63.2010.3.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AIMS Videothoracoscopy plays a leading role in the management of spontaneous pneumothorax. This study evaluates various treatment strategies based on early results. PATIENTS AND METHODS In a five-year period 243 (184 male, 59 female, mean age: 37.1 years) patients were treated with spontaneous pneumothorax in 302 cases. In case of partial ptx observation was used in 24 (8%) and aspiration in 6 (2%) patients. Chest drain was inserted in 241 (67.6%) cases. Indications for surgery were recurrence of disease, previous contralateral pneumothorax and failure of drainage. Videothoracoscopy was indicated in 71 (23.5%), Jakoscopy in 5 (1.7%), thoracotomy in 13 (4.3%) cases. The operation was completed with partial pleurectomy in 25, talcum or mechanical pleurodesis in 32 and 3 cases, respectively. RESULTS Conservative treatment was successful in 24 (80%) of the 30 conservatively treated cases, while chest drainage succeeded in 204 (84.7%) of the 241 cases. Conversion was needed in 8 (11.3%) cases of the 71 VATS. The remaining 63 patients recovered. Thoracotomy and Jakoscopy were successful in all cases. The postoperative complication rate was 6.3% after VATS, and 7.7% after thoracotomy. Reoperation was performed because bleeding in one case after VATS and thoracotomy. In one case empyema, and in another patient pneumonia developed after VATS. Postoperative bleeding occurred in one case after thoracotomy. The mean hospitalization was 8.5 days after drainage, 9.1 days after VATS and 11.3 days after thoracotomy. The postoperative mortality rate was 1.3% (4 patients). CONCLUSIONS In case of spontaneous pneumothorax the first choice of therapy is chest tube drainage. VATS is indicated in case of recurrence, failure of drainage and previous contralateral pneumothorax.
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Affiliation(s)
- Zsolt Szentkereszty
- Mellkassebészeti Központ, Debreceni Egyetem Orvos- és Egészségtudományi Centrum, Sebészeti Intézet Debrecen
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Olavarrieta JRL, Coronel P. Expectations and patient satisfaction related to the use of thoracotomy and video-assisted thoracoscopic surgery for treating recurrence of spontaneous primary pneumothorax. J Bras Pneumol 2009; 35:122-8. [PMID: 19287914 DOI: 10.1590/s1806-37132009000200004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Accepted: 07/01/2008] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare the outcomes of thoracotomy and video-assisted thoracoscopic surgery (VATS) in the treatment of recurrence of primary spontaneous pneumothorax. METHODS Medical records of patients presenting recurrence of primary spontaneous pneumothorax were retrospectively reviewed. Patients were divided into two groups: those who underwent conservative thoracotomy (n = 53, thoracotomy group); and those who underwent VATS (n = 47, VATS group). RESULTS Although there were no deaths in either group and the length of hospital stays was similar between the two, there was greater morbidity in the thoracotomy group. Patients in the thoracotomy group required more pain medication for longer periods than did those in the VATS group (p < 0.05). In the thoracotomy group, the rate of recurrence was 3%. Pain was classified as insignificant at one month after the operation by 68% of patients in the VATS group and by only 21% of those in the thoracotomy group (p < 0.05). At three years after the surgical procedure, 97% of the VATS group patients considered themselves completely recovered from the operation, compared with only 79% in the thoracotomy group (p < 0.05). Chronic or intermittent pain, requiring the use of analgesics more than once a month, was experienced by 90% of the thoracotomy group patients and 3% of the VATS group patients. In addition, 13% of the thoracotomy group patients required clinical pain management. CONCLUSIONS We recommend VATS as the first-line surgical treatment for patients with recurrent primary spontaneous pneumothorax.
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Affiliation(s)
- Jorge Ramón Lucena Olavarrieta
- Universidad Central de Venezuela, Cátedra de Técnica Quirúrgica, Instituto Anatómico José Izquierdo, Caracas, Venezuela.
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Chang Y, Chou S, Kao E, Chuang H, Li H, Lee J, Huang M. Video‐assisted extrathoracic bleb excision: An ultra‐minithoracotomy for primary spontaneous pneumothorax. MINIM INVASIV THER 2009; 16:323-7. [DOI: 10.1080/13645700701702200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Orki A, Demirhan R, Ciftci H, Coskun T, Kutlu CA, Arman B. Videothoracoscopic approach to recurrence primary spontaneous pneumothorax: using of electrocoagulation in small bulla/blebs. Indian J Surg 2009; 71:19-22. [PMID: 23133103 DOI: 10.1007/s12262-009-0005-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2008] [Accepted: 12/31/2008] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of electrocoagulation of bullae/blebs and apical pleurectomy via videothoracoscopic approach. METHODS We reviewed 42 patients who underwent Videoassisted thoracoscopy (VATS) procedure for recurrence primary spontaneous pneumothorax (PSP) from 200022006. There were 30 male and 12 female patients with a median age of 30 years. The percentage of pneumothorax was calculated median of 60% (British Thoracic Society Guideline - 2003). Thirty-two (76.2%) bullae/blebs were observed with the median diameter of 15 mm (5-30). RESULTS Bulla ablation via cauterisation and apical pleurectomy was performed in 32 patients. Ten patients underwent only apical pleurectomy/abrasion because in this group there was not any either bulla or bleb could be found. The median duration of drainage time was 3 days. There was no mortality and complications occurred in five (11.9%) patients. Only two (4.76%) recurrence occurred during the 52 months (5 to 76) median follow-up period. CONCLUSION Videothoracoscopic bulla ablation with apical pleurectomy is a safe method for recurrence PSP. Especially, if the bulla or bleb is smaller than 20 mm the ablation via cauterisation reduces the expenses of VATS procedure by avoiding the use of stapler devices.
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Affiliation(s)
- Alpay Orki
- Department of Thoracic Surgery, Maltepe University, Istanbul, Turkey
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Kitagawa H, Akimori T, Okabayashi T, Namikawa T, Sugimoto T, Kobayashi M, Hanazaki K. Total laparoscopic gastric mobilization for esophagectomy. Langenbecks Arch Surg 2008; 394:617-21. [PMID: 18542990 DOI: 10.1007/s00423-008-0354-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 05/09/2008] [Indexed: 02/05/2023]
Affiliation(s)
- Hiroyuki Kitagawa
- Department of Surgery, Kochi Medical School, Kohasu-Okocho, Nankoku-City, Kochi, 783-8505, Japan
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Yamada S, Yoshino K, Inoue H. Simultaneous Bilateral Spontaneous Pneumothorax With Pleural Window Communicating With Bilateral Pleural Spaces. Ann Thorac Surg 2008; 85:1434-6. [DOI: 10.1016/j.athoracsur.2007.10.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Revised: 10/01/2007] [Accepted: 10/08/2007] [Indexed: 10/22/2022]
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Video-Assisted Thoracoscopic Surgery (VATS) Vs Thoracotomy in the Surgical Treatment of Recurrent Spontaneous Pneumothorax. POLISH JOURNAL OF SURGERY 2008. [DOI: 10.2478/v10035-008-0013-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Barker A, Maratos EC, Edmonds L, Lim E. Recurrence rates of video-assisted thoracoscopic versus open surgery in the prevention of recurrent pneumothoraces: a systematic review of randomised and non-randomised trials. Lancet 2007; 370:329-35. [PMID: 17662881 DOI: 10.1016/s0140-6736(07)61163-5] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Evidence supporting similar recurrence rates between video-assisted and open surgery for the treatment of recurrent pneumothorax is questionable, because the number of randomised trials is sparse and they are underpowered to detect any meaningful difference. Our aim was to do a systematic review of randomised and non-randomised studies to compare recurrence rates between the two forms of surgical access. METHODS We did a systematic literature search for studies on pneumothorax surgery in Medline, Embase, Cochrane Library, trial registers on the internet, and conference abstracts, and identified 29 studies (four randomised and 25 non-randomised) eligible for inclusion. Meta-analysis was done by combining the results of reported recurrence rates in patients undergoing video-assisted thoracoscopic surgery compared with those having open surgery. Both fixed and random effects models were applied to the results pooled for analysis. RESULTS In studies that did the same pleurodesis through two different forms of access, the relative risk (RR) of recurrences in patients undergoing video-assisted surgery compared with open surgery was similar between non-randomised and randomised studies (RR 4.880 [95% CI 2.670-8.922] vs 3.951 [0.858-18.193]), yielding an overall RR of 4.731 (2.699-8.291; p<0.0001). There was no evidence to suggest heterogeneity of trial results (p=0.88). The high RR of recurrence for video-assisted surgery remained robust to a random effects model (4.051 [1.996-7.465]; p<0.0001), by including all comparative studies (3.991 [2.584-6.164]; p<0.0001), with only high-quality studies used (4.016 [1.8468.736]; p<0.0001), and on a simulation biased in favour of video-assisted surgery when there were no events in either group (3.559 [2.165-5.852]; p<0.0001). INTERPRETATION Both randomised and non-randomised trials are consistent in recurrence of pneumothoraces and show a four-fold increase when a similar pleurodesis procedure is done with a video-assisted approach compared with an open approach.
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Affiliation(s)
- Allanah Barker
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
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31
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Ben-Nun A, Soudack M, Best LA. Video-Assisted Thoracoscopic Surgery for Recurrent Spontaneous Pneumothorax: The Long-term Benefit. World J Surg 2006; 30:285-90. [PMID: 16479351 DOI: 10.1007/s00268-005-0235-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Management of recurrent primary spontaneous pneumothorax by open surgery was considered the treatment of choice until recently. The major drawbacks of this management are the prolonged postoperative pain and cosmetic results. In the last decade, video-assisted thoracoscopic surgery (VATS) has replaced the routine use of open surgery. Most papers that compared limited open surgery to VATS addressed the early postoperative results, and studies that assessed the long-term results focused primarily on the rate of recurrence and pulmonary function tests. The aim of this study was to compare the outcome of minithoracotomy and VATS with emphasis on patients' long-term, subjective perspective and satisfaction. METHODS Medical records of patients with recurrent primary spontaneous pneumothorax were retrospectively reviewed. Patients who underwent surgical treatment by limited thoracotomy (63 patients) or VATS (58 patients) more than 3 years ago were enrolled. Hospital medical charts were used to compare the early postoperative results. Outpatient clinic records and a telephone questionnaire were employed to evaluate long-term results. RESULTS There was no mortality or major morbidity in either group, and hospitalization time was similar. Patients in the thoracotomy group needed significantly higher doses of narcotic analgesia for a longer period. There were two cases of recurrence in the VATS group (3%). Seventy-eight percent of patients in the VATS and 21% in the thoracotomy group classified their pain as insignificant a month following the operation (P < 0.05). Three years following surgery, 97% of the VATS group patients considered themselves completely recovered from the operation compared with only 79% in the thoracotomy group (P < 0.05). Nineteen percent of the thoracotomy group and 3% of the VATS group suffered from chronic or intermittent pain necessitating use of analgesics more than once a month. Thirteen percent of patients from the open procedure group required services from the pain clinic. Patients in the VATS group were, in general, much more satisfied with their operation and with the surgical scars compared with patients from the thoracotomy group. CONCLUSION We recommend video-assisted surgery as the first-line surgical treatment for patients with recurrent primary spontaneous pneumothorax. This recommendation is based on its somewhat favorable early postoperative course, the superior long-term outcome, and patient satisfaction.
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Affiliation(s)
- A Ben-Nun
- Department of General Thoracic Surgery, Rambam Medical Center, Haifa, 31096, Israel.
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Abstract
Lateral thoracotomies include many different variants with a common final pathway, consisting of an intercostal incision. They are the most frequent incisions in daily thoracic procedures. Axillary thoracotomy has increased the interest in muscle-sparing approaches. Surgical techniques, indications, pitfalls and tips are described. Discussion and an overview of the literature are developed.
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Affiliation(s)
- Nicolas Dürrleman
- Hôpitaux Universitaires de Strasbourg, Département de Chirurgie Thoracique, Hôpital Civil, 1 Place de l'Hôpital, 67000 Strasbourg, France
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