Videothoracoscopic surgical approach for spontaneous pneumothorax: review of the pertinent literature

With advances in videothoracoscopic equipment, most operations for spontaneous pneumothorax are usually performed with a minimally invasive technique that involves video-assisted thoracoscopic surgery (VATS) [1]. Additionally, VATS has the advantage that inspection of the pleura and lung is more complete than when carried out through limited thoracotomy. This VATS procedure is generally done in the full lateral decubitus position under general anesthesia [2-4]. Many researchers have reported a variety of techniques for the treatment of spontaneous pneumothorax via VATS. In this report we review the literature on the VATS approach for spontaneous pneumothorax.Patients with spontaneous pneumothorax, which is usually caused by a rupture of a subpleural bleb or bulla in the underlying lung, most commonly present with ipsilateral sudden chest pain and dyspnea. Spontaneous pneumothoraces are classified as primary or secondary [5-7]. Primary spontaneous pneumothorax occurs in otherwise healthy patients, most commonly in tall, young, lean males and particularly in those who smoke [7]. Secondary spontaneous pneumothorax occurs as a complication of an underlying lung disease, which most often is chronic obstructive pulmonary disease [5,7]. In either case, the goals of pneumothorax treatment are to eliminate intrapleural air collection and to prevent recurrence. In the first episodes of spontaneous pneumothorax, observation, simple aspiration, or chest tube drainage in proportion to clinical stability or the degree of pneumothorax are recommended as first-line therapies [6-12]. The recurrence rate after these therapies has been reported to range from 16% to 52%, with a mean of 30% [5,10,12,13]. Treatment to prevent recurrent pneumothorax is essential under clinical conditions such as spontaneous pneumothorax with potential respiratory insufficiency, recurrent spontaneous pneumothorax, or persistent pneumothorax. Under these conditions, a surgical option is considered for pneum