Video assisted thoracoscopic management of primary spontaneous pneumothorax.

Although Video-Assisted Thoracoscopic Surgery (VATS) is now accepted by many as the approach of choice in the management of primary spontaneous pneumothorax (PSP), the optimal procedure and the timing of surgical intervention remain areas of contention. The authors reviewed their combined experience with 518 consecutive VATS procedures for PSP in 483 patients. Mechanical pleurodesis was performed in every case and was the only procedure in 20 patients. We had experience with several means of eliminating subpleural bullae once identified: stapled bullectomy (196), endoloop (261), argon beam coagulation (6) and endoscopic suturing (35). There were no mortality or intraoperative complications. Median postoperative hospital stay was 3 days. So far, we have had 9 recurrences (1.74%), after a mean follow up of 20 months (range one to 36 months). Complications consisted of 18 persistent air leaks, 14 would infections and 1 chest wall bleeding. We conclude that (1) VATS is a safe and effective approach in the treatment of PSP; (2) Stapled-bullectomy is quick and reliable but costly; (3) Endoloop and suturing are viable alternative techniques that may prove to be more cost effective; (4) we do not recommend to use argon beam coagulation as the primary treatment modality.