Expert consensus on spontaneous ventilation video-assisted thoracoscopic surgery in primary spontaneous pneumothorax (Guangzhou)

Primary spontaneous pneumothorax (PSP) has an estimated incidence ranging from 17–24/100,000 and 1–6/100,000 among males and females, respectively (1,2). It usually occurs in tall thin individuals between 10–30 years of age, especially smokers (3). Common symptoms include chest pain and mild dyspnea (4). Besides, PSP is highly recurrent with rates ranging from 17% to 54% within 1–6 years (2). In particular, patients can experience contralateral PSP with a reported rate ranging from 5% up to 27% with the highest rates reported in patients with contralateral bullae at the high-resolution-computed-tomography (HRCT) scans (5). HRCT has shown that more than 50% of patients with unilateral PSP have pulmonary bullae in the contralateral lung (6). Surgical treatment of PSP is indicated in patients with recurrent or persistent lung collapse, hemopneumothorax, bilateral pneumothorax, and/or failed clinical observation or conservative treatment with simple thoracic drainage (7). Several studies have suggested the superiority of video-assisted thoracoscopic surgery (VATS) over a thoracotomy in the treatment of PSP due to lower postoperative pain and morbidity, and shorter hospital stay (8-11)