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Jiang L, Wang C, Tong J, Han X, Miao C, Liang C. Comparison between thoracic epidural analgesia VS patient controlled analgesia on chronic postoperative pain after video-assisted thoracoscopic surgery: A prospective randomized controlled study. J Clin Anesth 2025; 100:111685. [PMID: 39608098 DOI: 10.1016/j.jclinane.2024.111685] [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: 08/05/2024] [Revised: 09/13/2024] [Accepted: 11/10/2024] [Indexed: 11/30/2024]
Abstract
STUDY OBJECTIVE To test the hypothesis that thoracic epidural anesthesia and analgesia (TEA) reduces the incidence of chronic postoperative pain (CPSP) after video-assisted thoracoscopic surgery (VATS). DESIGN A single-center, single-blind, randomized controlled trial was conducted. SETTING The study was conducted in the operating room, with follow-up assessments performed in the ward. Telephone was used to follow the long-term outcomes. PATIENTS 231 patients ≥18 years of age and scheduled for VATS. INTERVENTIONS Patients were randomized into two groups, including an epidural block (EPI) group (general anesthesia with patient-controlled epidural analgesia) and a general anesthesia with patient-controlled intravenous analgesia (PCIA) group. MEASUREMENTS The primary endpoint was the incidence of CPSP at 3 months postoperatively. CPSP data, including acute pain, neuropathic pain, depression, and side effects, were collected at 3 and 6 months postoperatively through telephone follow-up. MAIN RESULTS A total of 231 patients were analyzed, including 114 in the PCIA group and 117 in the EPI group. Sixty-six patients (56.4 %) in the PCIA group and 33 patients (28.9 %) in the EPI group experienced chronic pain at 3 months postoperatively. The odds ratio (OR) was 0.31 (95 % confidence interval [CI], 0.18 to 0.54; P < 0.0001). After adjusting for confounding factors, the adjusted OR was 0.28 (95 % CI, 0.16 to 0.50, P < 0.001). Six months postoperatively, 50 (42.7 %) and 17 (14.9 %) patients in the PCIA and EPI groups, respectively, were diagnosed with CPSP (P < 0.0001).
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MESH Headings
- Humans
- Thoracic Surgery, Video-Assisted/adverse effects
- Thoracic Surgery, Video-Assisted/methods
- Pain, Postoperative/prevention & control
- Pain, Postoperative/etiology
- Male
- Female
- Analgesia, Patient-Controlled/methods
- Analgesia, Patient-Controlled/statistics & numerical data
- Analgesia, Epidural/methods
- Analgesia, Epidural/adverse effects
- Middle Aged
- Prospective Studies
- Single-Blind Method
- Chronic Pain/prevention & control
- Chronic Pain/etiology
- Aged
- Adult
- Pain Measurement/statistics & numerical data
- Anesthesia, General/adverse effects
- Anesthesia, General/methods
- Treatment Outcome
- Follow-Up Studies
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Affiliation(s)
- Ling Jiang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chengyu Wang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jie Tong
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaodan Han
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Changhong Miao
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Anesthesiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, People's Republic of China.
| | - Chao Liang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Anesthesiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, People's Republic of China.
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Liu Y, Wang C, Ye Z, Jiang L, Miao C, Liang C. Effects of epidural anesthesia and analgesia on the incidence of chronic pain after thoracoscopic lung surgery: A retrospective cohort study. Heliyon 2024; 10:e35436. [PMID: 39165959 PMCID: PMC11334903 DOI: 10.1016/j.heliyon.2024.e35436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 07/24/2024] [Accepted: 07/29/2024] [Indexed: 08/22/2024] Open
Abstract
Objective Chronic postoperative pain (CPSP) is common after thoracic surgery, even after the less invasive video-assisted thoracoscopic surgery (VATS). This study investigated the effect of thoracic epidural anesthesia (TEA) on the development of CPSP. Materials We retrospectively analyzed the data of patients who underwent VATS at our center between 2020 and 2022. The enrolled patients were divided into the epidural block (EPI) and patient-controlled intravenous analgesia (PCIA) groups. A telephone questionnaire was used to collect information regarding CPSP, which was defined as a numerical rating scale (VAS) score ≥1 at 3 or 6 months postoperatively. Additionally, statistical analyses were performed to identify the risk factors for CPSP in the two groups. Results Overall, 894 patients completed the follow-up interviews at 3 and 6 months, with 325 and 569 patients in the PCIA and EPI groups, respectively. The incidence rates of CPSP in the PCIA group at 3 and 6 months were 16.9 % (95 % confidence interval [CI]: 9.3-32.7 %) and 13.5 % (95 % CI: 8.7-33.4 %), and 10.3 % (95 % CI: 8.1-30.5 %) and 3.6 % (95 % CI: 3.5-21.5 %) in EPI group, respectively. The incidence of CPSP at 3 months (P = 0.0048) and 6 months (P < 0.005) was statistically significant in both groups. Age and lymph node dissection were significantly associated with CPSP. Conclusions Compared to PCIA, TEA was associated with a lower incidence of CPSP after VATS, and should be considered an important part of the analgesia regimen for patients with VATS.
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Affiliation(s)
- Yiming Liu
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chenyu Wang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhixiang Ye
- Department of Anesthesiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Ling Jiang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Changhong Miao
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Anesthesiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Chao Liang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Anesthesiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
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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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Thoracoscopy for Spontaneous Pneumothorax. J Clin Med 2021; 10:jcm10173835. [PMID: 34501282 PMCID: PMC8432077 DOI: 10.3390/jcm10173835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 11/17/2022] Open
Abstract
Video-assisted thoracic surgery (VATS) is the treatment of choice for recurrence prevention in patients with spontaneous pneumothorax (SP). Although the optimal surgical technique is uncertain, bullous resection using staplers in combination with mechanical pleurodesis, chemical pleurodesis and/or staple line coverage is usually undertaken. Currently, patient satisfaction, postoperative pain and other perioperative parameters have significantly improved with advancements in thoracoscopic technology, which include uniportal, needlescopic and nonintubated VATS variants. Ipsilateral recurrences after VATS occur in less than 5% of patients, in which case a redo-VATS is a feasible therapeutical option. Randomized controlled trials are urgently needed to shed light on the best definitive management of SP.
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Risk factors for recurrent spontaneous pneumothorax: A population level analysis. Am J Surg 2021; 223:404-409. [PMID: 34119331 DOI: 10.1016/j.amjsurg.2021.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/27/2021] [Accepted: 05/27/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND We sought to determine the rate and risk factors of recurrent spontaneous pneumothorax in a diverse population. METHODS Cohort study using the California Public Discharge Data file (1995-2010). We identified patients with first-time spontaneous pneumothorax. The primary outcome was recurrent pneumothorax. Associations with clinical, patient, and hospital characteristics were assessed using Cox regression analysis. RESULTS Among 14,609 patients with a first-time episode of spontaneous pneumothorax, 26.2% developed a recurrence. Risk factors included age <35 (Hazard Ratio [HR] 1.24 95%-Confidence Interval [CI] 1.14-1.36), Asian race (HR 1.24, CI 1.13-1.37), and tube thoracostomy (HR 1.2, CI 1.15-1.31). Mechancial pleurodesis (HR 0.37 CI 0.31-0.45) was superior to chemical pleurodesis (HR 0.71 CI 0.58-0.86) in reducing recurrence risk. CONCLUSIONS The risk of recurrent pneumothorax is greatest in patients age <35, Asians, and those requiring a tube thoracostomy. The risks of operative intervention should be balanced against patient risk for recurrence.
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Sim SKR, Nah SA, Loh AHP, Ong LY, Chen Y. Mechanical versus Chemical Pleurodesis after Bullectomy for Primary Spontaneous Pneumothorax: A Systemic Review and Meta-Analysis. Eur J Pediatr Surg 2020; 30:490-496. [PMID: 31600803 DOI: 10.1055/s-0039-1697959] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Primary spontaneous pneumothorax (PSP) and its high recurrence rate pose a therapeutic challenge to both patients and their managing surgeons. Mechanical or chemical pleurodesis can be used to prevent recurrence, but the optimal treatment often remains a matter of debate. This meta-analysis aims to compare the outcomes between mechanical and chemical pleurodesis following bullectomy for PSP. MATERIALS AND METHODS Studies published up to 2019 were searched from Medline, Embase, Google Scholar, and Cochrane databases. A meta-analysis of randomized controlled trials (RCTs) and observational cohort studies (OCSs) comparing outcomes between mechanical and chemical pleurodesis for PSP was performed. RESULTS Seven studies (one RCT and six OCSs) were included, comprising 1,032 cases of mechanical (799 abrasions, 202 pleurectomies, and 31 unspecified abrasions/pleurectomies/both), and 901 cases of chemical (643 talc, 69 minocycline, and 189 unspecified talc/kaolin) pleurodesis. The recurrence rate of pneumothorax after chemical pleurodesis (1.2%) was significantly lower than mechanical pleurodesis (4.0%) (pooled odds ratio [OR] = 3.00; 95% confidence interval [CI] = 1.59-5.67; p = 0.0007; I 2 = 19%). Hospital stay was also slightly shorter in the chemical pleurodesis group (pooled mean difference [MD] = 0.42 days; 95% CI = 0.12-0.72; p = 0.005; I 2 = 0%). There was no statistically significant difference in postoperative complications (pooled OR = 1.18; 95%CI = 0.40-3.48; p = 0.76; I 2 = 71%) and operative time (pooled MD = 3.50; 95%CI = -7.28 to 14.28; p = 0.52; I 2 = 99%) between these two groups. CONCLUSION Chemical pleurodesis is superior to mechanical pleurodesis following bullectomy for PSP in reducing hospital stay and recurrence rate. However, more RCTs with longer follow-up are necessary to demonstrate the benefit of chemical pleurodesis for PSP.
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Affiliation(s)
- Sarah Kher Ru Sim
- Department of General Surgery, Singapore General Hospital, Singapore
| | - Shireen Anne Nah
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Amos Hong Pheng Loh
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Lin Yin Ong
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Yong Chen
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
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Zhu P, Xia H, Sun Z, Zhu D, Deng L, Zhang Y, Zhang H, Wang D. Manual aspiration versus chest tube drainage in primary spontaneous pneumothorax without underlying lung diseases: a meta-analysis of randomized controlled trials. Interact Cardiovasc Thorac Surg 2019; 28:936-944. [PMID: 30608581 DOI: 10.1093/icvts/ivy342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 11/07/2018] [Accepted: 11/19/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Although primary spontaneous pneumothorax (PSP) is an extremely frequent pathology, there is still no clear consensus on the treatment for these patients. We performed a strict meta-analysis on the effectiveness of manual aspiration (MA) compared to chest tube drainage (CTD) for the treatment of PSP. METHODS A literature search was performed on PubMed, EMBASE and the Cochrane Library to identify randomized controlled trials comparing MA with CTD for the treatment of PSP. Independent reviewers evaluated the methodological quality of the included randomized controlled trials. Statistical heterogeneity among studies was quantitatively evaluated using the I-squared index. RESULTS Five randomized controlled trials were included, and a total of 358 subjects were reported on. We found that MA was related to significantly shorter hospital stays [in days; mean difference -1.70, 95% confidence interval (CI) -2.36 to -1.04; P < 0.00001, fixed effect model] compared with CTD. However, no significant differences were found between the 2 treatments for immediate success rate (risk ratio 1.15, 95% CI 0.73-1.81; P = 0.54), 1-year recurrence rate, 1-week success rate, time of recurrence, chest surgery rate or complication rate. Subgroup analysis showed that MA can provide a significantly lower hospitalization rate than CTD with a tube size of >12 Fr or a water seal drainage system. CONCLUSIONS On the basis of the currently available literature, MA is advantageous in the treatment of PSP because of shorter hospital stays. The subgroup analysis also indicates that MA can provide a lower hospitalization rate than CTD with a tube size of >12 Fr or a water seal drainage system. However, there are no significant differences between the 2 interventions with respect to immediate success rate, 1-year recurrence rate, 1-week success rate, time of recurrence, chest surgery rate or complication rate.
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Affiliation(s)
- Pengzhi Zhu
- Department of Cardio-Thoracic Surgery, Tianjin Hospital, Hexi District, Tianjin, China
| | - Honggang Xia
- Department of Cardio-Thoracic Surgery, Tianjin Hospital, Hexi District, Tianjin, China
| | - Zhongyi Sun
- Department of Cardio-Thoracic Surgery, Tianjin Hospital, Hexi District, Tianjin, China
| | - Deqing Zhu
- Department of Cardio-Thoracic Surgery, Tianjin Hospital, Hexi District, Tianjin, China
| | - Limin Deng
- Department of Cardio-Thoracic Surgery, Tianjin Hospital, Hexi District, Tianjin, China
| | - Yongmin Zhang
- Department of Cardio-Thoracic Surgery, Tianjin Hospital, Hexi District, Tianjin, China
| | - Haiquan Zhang
- Department of Cardio-Thoracic Surgery, Tianjin Hospital, Hexi District, Tianjin, China
| | - Dongbin Wang
- Department of Cardio-Thoracic Surgery, Tianjin Hospital, Hexi District, Tianjin, China
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Chan IC, Lee YS, Chuang CM, Soong WJ. The influence of pleurodesis on the outcome of primary spontaneous pneumothorax in children. J Chin Med Assoc 2019; 82:305-311. [PMID: 30865105 DOI: 10.1097/jcma.0000000000000073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Primary spontaneous pneumothorax (PSP) has a high rate of recurrence, and pleurodesis has been shown to decrease the rate of recurrence in adult PSP. For pediatric PSP patients, there are only a few case series available and evidence on the benefits of pleurodesis is insufficient. This study aimed to analyze the outcome of pleurodesis among pediatric PSP patients via a nationwide population-based cohort in Taiwan. METHODS The hospitalization data from the pediatric intensive care sampling file of the National Health Insurance Research Database from January 1 to December 31, 2010, were retrieved and analyzed. Children aged 0-18 years with a discharge diagnosis of PSP (ICD-9: 512, 512.0, and 512.8) were enrolled in the study. Demographic data, management strategies, and clinical outcomes were recorded and analyzed as well. RESULTS A total of 1005 hospitalization cases were identified and divided into the pleurodesis (409 hospitalizations) and nonpleurodesis (596 hospitalizations) groups. In the univariate analysis, thoracoscopic surgery for PSP decreased the incidence of recurrence (hazard ratio [HR], 0.46; 95% CI, 0.32-0.67) and the need for further surgical intervention (HR, 0.29; 95% CI, 0.18-0.47); however, conventional open surgery did not. A lesser incidence of PSP recurrence (HR, 0.53; 95% CI, 0.37-0.78) and fewer subsequent surgical interventions (HR, 0.32; 95% CI, 0.20-0.52) were found in the pleurodesis group in comparison with the nonpleurodesis group. A multivariate Cox regression analysis revealed that pleurodesis was the only significant factor capable of decreasing the incidence of PSP recurrence (HR, 0.57; 95% CI, 0.38-0.86) and the need for further surgical intervention (HR, 0.40; 95% CI, 0.23-0.69). CONCLUSION Pleurodesis reduces the rate of recurrence and the need for further surgical intervention in pediatric PSP. It may be considered as the method of choice for the management of PSP in children.
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Affiliation(s)
- I-Ching Chan
- Department of Pediatrics, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan, ROC
| | - Yu-Sheng Lee
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chieh-Mao Chuang
- Department of Pediatric Cardiology, China Medical University Children Hospital, Taichung, Taiwan, ROC
| | - Wen-Jue Soong
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
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Plojoux J, Froudarakis M, Janssens JP, Soccal PM, Tschopp JM. New insights and improved strategies for the management of primary spontaneous pneumothorax. CLINICAL RESPIRATORY JOURNAL 2019; 13:195-201. [PMID: 30615303 DOI: 10.1111/crj.12990] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 12/14/2018] [Accepted: 12/24/2018] [Indexed: 12/22/2022]
Abstract
The pathophysiology and management of primary spontaneous pneumothorax (PSP) are a subject of debate. Despite advances in the understanding of its etiopathogenesis and improvements in its management, implementation in clinical practice is suboptimal. In this manuscript, we review the recent literature with a focus on PSP pathophysiology and management. Blebs and emphysema-like changes (ELC) are thought to contribute to the pathophysiology of PSP but cannot explain all cases. Recent studies emphasize the role of a diffuse porosity of the visceral pleura. Others found a relationship between smoking, occurrence of a PSP and bronchiolitis, which could be the initial pathological process leading to ELC development. Recent or ongoing studies challenge the need to systematically remove air from the pleural cavity of stable patients, introducing conservative management as a valuable therapeutic option. Evidence is growing in favour of needle aspiration instead of chest tube insertion, when air evacuation is needed. In addition, ambulatory management is considered as a successful approach in meta-analyses and is under exploration in a large randomized study. Because of a high recurrence rate of PSP, the benefit of performing a pleurodesis at first occurrence is under evaluation with interesting but not generalizable results. Better identification of 'at risk patients' is needed to improve the investigation strategy. Finally, recent publications confirm the efficacy, security and cost-effectiveness of graded talc poudrage pleurodesis to prevent PSP recurrence. In conclusion, PSP pathophysiology and management are still under investigation. The results of recently published and ongoing studies should be more widely implemented in clinical practice.
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Affiliation(s)
- Jérôme Plojoux
- Division of Pneumology, University Hospitals of Geneva, Geneva, Switzerland
| | - Marios Froudarakis
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Jean-Paul Janssens
- Division of Pneumology, University Hospitals of Geneva, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Paola M Soccal
- Division of Pneumology, University Hospitals of Geneva, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Jean-Marie Tschopp
- Centre Valaisan de Pneumologie, Department of Internal Medicine, Montana, Switzerland
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Asghar Nawaz M, Apparau D, Zacharias J, Shackcloth M. Approach to pneumothorax surgery: a national survey of current UK practice. Asian Cardiovasc Thorac Ann 2019; 27:180-186. [PMID: 30661376 DOI: 10.1177/0218492319825943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pneumothorax is a common condition with various management options. We aimed to determine the current surgical practice in the United Kingdom. METHOD An online questionnaire regarding surgical strategy was sent to all consultants who were members of the Society for Cardiothoracic Surgery (80 thoracic). RESULTS Fifty-six consultants, mainly thoracic, responded to the survey. Video-assisted thoracoscopic surgery was unanimously the preferred approach, the majority (59%) using 3 ports. Regarding the timing of surgery, 53 (95%) surgeons would intervene at first presentation with persistent air leak and/or lung collapse, 41 (73%) for a first bilateral pneumothorax, 22 (39%) only for recurrent pneumothorax, and 18 (32%) for the first computed tomography evidence of bullae. Apical bullectomy + pleurectomy was the preferred technique for 26 (46%) surgeons, and apical bullectomy + apical pleurectomy + pleural abrasion was the choice for 13 (23%). Some surgeons were concerned about talc and avoid it. The majority (70%) used a single apical drain with or without 24-48 h suction. Regarding chest radiography, the response was variable but 48% performed immediate postoperative and/or daily chest radiographs. Currently, most surgeons (59%) use digital drains and feel it monitors air leaks better. The perceived chronic pain (1%-3%) and recurrence rates (0%-3%) were stated by 59% and 86%, respectively. CONCLUSION There is variability in the surgical management of pneumothorax among surgeons across the UK, but they all use video-assisted thoracoscopic surgery as the intervention of choice for pneumothorax surgery, and there is a shift towards early surgical intervention.
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Affiliation(s)
| | - Denish Apparau
- 1 Manchester University NHS Foundation Trust, Manchester, UK
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Elective surgery treatment in patient living in rural area with history of recurrent primary spontaneous pneumothorax: A procedure to avoid in absence of pneumothorax. A case report. Int J Surg Case Rep 2018; 53:483-485. [PMID: 30567075 PMCID: PMC6277214 DOI: 10.1016/j.ijscr.2018.11.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/20/2018] [Accepted: 11/21/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Pneumothorax is defined as accumulation of air in the pleural space with secondary lung collapse resulting in dyspnea or chest pain. Currently the optimal management of spontaneous pneumothorax has been standardized, but the question of elective surgery treatment remains unresolved in patients living in rural area with history of recurrent Primary spontaneous pneumothorax [PSP]. PRESENTATION OF CASE A 41 years-old white man living in rural area, with a history of recurrent right spontaneous pneumothorax (three subsequent episodes) treated by positioning of chest tube, was admitted to our unit. No respiratory symptoms and normal physical exam were observed on admission although anxiety states was noted. Chest CT scan showed small apical bullae in the right upper lobe without cystic change in the pulmonary parenchyma. DISCUSSION Recurrence of primary spontaneous pneumothorax represents a complication most frequently occurring within the first year. Among the treatment options, surgical management is needed in 25-50% of all patients suffering from PSP, due to persistent air leak or recurrence. We report the operative complications after elective surgery in a white man living in rural area with a history of recurrent right primary spontaneous pneumothorax. CONCLUSION This case report highlights that elective surgery in patients living in rural area with history of recurrence PSP can lead to post-operative complications as bleeding or prolonged air leaks following the lysis of multiple pleural adhesions.
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Schnell J, Koryllos A, Lopez-Pastorini A, Lefering R, Stoelben E. Spontaneous Pneumothorax. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 114:739-744. [PMID: 29169430 DOI: 10.3238/arztebl.2017.0739] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 03/13/2017] [Accepted: 07/31/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Few reliable data are available on the epidemiology and treatment of spontaneous pneumothorax. We studied the sex and age distribution, frequency of hospitalization, mortality, and conservative versus surgical care of this condition in Germany in order to draw well-founded conclusions about its in-hospital diagnosis and treatment. METHODS Data from all patients aged 10 or older who were hospitalized in the period 2011-2015 with a main discharge diagnosis of pneumothorax of neither traumatic nor iatrogenic origin were retrieved from the German Federal Statistical Office. Because of their source, all data were based on case numbers rather than patient numbers. RESULTS During the period of the study, there were 52 738 admissions with the main diagnosis of spontaneous pneumothorax, corresponding to an annual frequency of hospitalization of 14.3 per 100 000 persons per year (95% confidence interval, 14.0 to 14.5). Men were more frequently affected than women. The lethality and in-hospital mortality of this condition (≤ 0.08% and ≤ 0.3%, respectively) were low among persons aged 15 to 45, but markedly higher in persons over age 90 (9.4% and 15.9%, respectively). The frequency of accompanying pulmonary diagnoses also rose with age. Computerized tomography (CT) was performed in 38.9-54.6% of hospitalizations, depending on age. Monitoring on an intensive care unit was carried out in 36% of cases. More than one-quarter of cases involved surgical treatment. CONCLUSION The danger to life and the likelihood of an accompanying pulmonary diagnosis are both low up to age 45. Treatment on an intensive care unit and computerized tomography of the chest should be performed only for strict indications in patients under age 45. The pathophysiological basis of the differing patterns of illness depending on age and sex requires further investigation.
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Affiliation(s)
- Jost Schnell
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln, Cologne, Germany
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Nachira D, Ismail M, Meacci E, Zanfrini E, Iaffaldano A, Swierzy M, Englisch J, Faber S, Ossami Saidy RR, Vita ML, Porziella V, Rueckert JC, Margaritora S. Uniportal vs. triportal video-assisted thoracic surgery in the treatment of primary pneumothorax-a propensity matched bicentric study. J Thorac Dis 2018; 10:S3712-S3719. [PMID: 30505556 DOI: 10.21037/jtd.2018.04.124] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The role of triportal video-assisted thoracoscopic surgery (VATS) is widely recognized for the treatment of primary spontaneous pneumothorax (PSP). The aim of this study was to assess the effectiveness and the potential advantages of uniportal VATS (U-VATS) for the treatment of PSP compared with triportal VATS. Methods A total of 104 triportal (n=39) and uniportal (n=65) VATS procedures where performed for the treatment of PSP in two University hospitals. The prospectively collected data of postoperative outcomes were retrospectively reviewed and a 1:1 propensity score matching analysis was performed to compare the two VATS approaches. Results No major adverse events occurred after operation. Compared with triportal-VATS, Uniportal-VATS showed the same effectiveness in terms of risk of recurrence (null in both groups), post-operative complications (P=1.000) and operating time (66.04±16.92 vs. 74.57±21.38 min, P=0.141). However, there was a statistically significant difference in favor of uniportal-VATS in terms of necessity of further access [0 vs. 7 (30.4%), P=0.004], chest tube duration (4.39±1.41 vs. 6.32±0.94 days, P<<0.001), postoperative hospital stay (4.78±1.31 vs. 6.61±1.67 days, P<<0.001), visual analogue pain score (VAS) at 24 hours (3.45±1.41 vs. 6.44±2.45, P<<0.001), number of patients who had pain after chest drain removal [1 (4.3%) vs. 16 (69.6%), P<<0.001], VAS after drainage removal (0.11±0.47 vs. 2.74±2.25, P<<0.001), postoperative pain duration (2.50±1.20 vs. 14.82±37.41 days, P<<0.001), pain killers intake (0.75±1.06 vs. 7.53±3.96 days, P=0.001), chronic paresthesia (level scale: 0 to 2; 0 vs. 0.52±0.66, P<<0.001), chronic neuralgia (0 vs. 0.43±0.59, P<<0.001) and cosmetic results (level scale: 0 to 3; 2.91±0.28 vs. 2.00±0.77, P<<0.001). Conclusions U-VATS is feasible and safe and may be a less invasive alternative to triportal VATS for the treatment of PSP because of its effectiveness in reducing postoperative pain, paresthesia, hospital stay and in improving cosmetic results.
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Affiliation(s)
- Dania Nachira
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Mahmoud Ismail
- Competence Center of Thoracic Surgery, Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Elisa Meacci
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Edoardo Zanfrini
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Amedeo Iaffaldano
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Marc Swierzy
- Competence Center of Thoracic Surgery, Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Julianna Englisch
- Competence Center of Thoracic Surgery, Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Svea Faber
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Ramin Raul Ossami Saidy
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Maria Letizia Vita
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Venanzio Porziella
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Jens C Rueckert
- Competence Center of Thoracic Surgery, Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stefano Margaritora
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
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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: 1.3] [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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15
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Dagnegård HH, Rosén A, Sartipy U, Bergman P. Recurrence rate after thoracoscopic surgery for primary spontaneous pneumothorax. SCAND CARDIOVASC J 2017; 51:228-232. [PMID: 28413911 DOI: 10.1080/14017431.2017.1316419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES There is an on-going discussion regarding the recurrence rate after surgery for primary spontaneous pneumothorax by video assisted thoracic surgery (VATS) or by thoracotomy access. This study aimed to describe the recurrence rate, and to identify a possible learning curve, following surgery for primary spontaneous pneumothorax by VATS. DESIGN All patients who underwent surgery for primary spontaneous pneumothorax by VATS at Karolinska University Hospital 2004-2013 were reviewed. Preoperative and operative characteristics were obtained from medical records. Patients were followed-up through telephone interviews or questionnaires and by review of medical records. The primary outcome of interest was time to recurrence of pneumothorax requiring intervention. Outcomes were compared between patients operated during 2004-June 2010 and July 2010-2013. RESULTS 219 patients who underwent 234 consecutive procedures were included. The mean follow-up times were 6.3 and 2.9 years in the early and late period, respectively. The postoperative recurrence rate in the early period was 16% (11%-25%), 18% (12%-27%), and 18% (12%-27%), at 1, 3 and 5 years, compared to 1.7% (0.4%-6.8%), 7.6% (3.7%-15%), and 9.8% (4.8%-19%) at 1, 3 and 5 years, in the late period (p = 0.016). CONCLUSIONS We found that the recurrence rate after thoracoscopic surgery for primary spontaneous pneumothorax decreased significantly during the study period. Our results strongly suggest that thoracoscopic surgery for pneumothorax involve a substantial learning curve.
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Affiliation(s)
- Hanna H Dagnegård
- a Section of Cardiothoracic Surgery , Karolinska University Hospital , Stockholm , Sweden
| | - Alice Rosén
- a Section of Cardiothoracic Surgery , Karolinska University Hospital , Stockholm , Sweden
| | - Ulrik Sartipy
- a Section of Cardiothoracic Surgery , Karolinska University Hospital , Stockholm , Sweden.,b Department of Molecular Medicine and Surgery , Karolinska Institutet , Stockholm , Sweden
| | - Per Bergman
- a Section of Cardiothoracic Surgery , Karolinska University Hospital , Stockholm , Sweden.,b Department of Molecular Medicine and Surgery , Karolinska Institutet , Stockholm , Sweden
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16
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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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Ota H, Kawai H, Kuriyama S. The Presence of a Reticulated Trabecula-Like Structure Increases the Risk for the Recurrence of Primary Spontaneous Pneumothorax after Thoracoscopic Bullectomy. Ann Thorac Cardiovasc Surg 2016; 22:139-45. [PMID: 26875751 DOI: 10.5761/atcs.oa.15-00306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Deteriorated alveolar structure at the base of blebs and bullae is known as the reticulated trabecula-like structure. Its clinical significance in primary spontaneous pneumothorax (PSP) remains unclear. This study aimed to investigate the impact of the structure on recurrence of PSP after video-assisted thoracoscopic surgery (VATS) bullectomy. METHODS Between April 2010 and March 2014, 80 cases of PSP in 76 patients who underwent VATS bullectomy using endoscopic staplers were included. The staple line was covered with polyglycolic acid sheets and fibrin glue. Cases were assigned to a normal alveolar structure (NAS) group (n = 54) and a reticulated trabecula-like structure (RT) group (n = 26) based on the histological analysis. Factors associated with recurrence were analysed using logistic regression. RESULTS The reticulated trabecula-like structure was significantly related to apical lung blebs. The recurrence rate of PSP was significantly higher in the RT group than in the NAS group (38.5% vs. 3.7%; P <0.001). On multivariate analysis, the reticulated trabecula-like structure was an independent factor for recurrence of PSP after VATS bullectomy. CONCLUSION The change of alveolar structure at the base of apical lung blebs would increase the risk for recurrence of PSP after VATS bullectomy.
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Affiliation(s)
- Hideki Ota
- Department of Thoracic Surgery, Akita Red Cross Hospital, Akita, Akita, Japan
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Salé A, Thépault F, Labalette M, Kerjouan M, De Latour B, Desrues B, Jouneau S. Premier épisode de pneumothorax spontané primaire : qui drainer, comment ? MEDECINE INTENSIVE REANIMATION 2016. [DOI: 10.1007/s13546-015-1156-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bintcliffe OJ, Hallifax RJ, Edey A, Feller-Kopman D, Lee YCG, Marquette CH, Tschopp JM, West D, Rahman NM, Maskell NA. Spontaneous pneumothorax: time to rethink management? THE LANCET. RESPIRATORY MEDICINE 2015; 3:578-88. [PMID: 26170077 DOI: 10.1016/s2213-2600(15)00220-9] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 05/14/2015] [Accepted: 05/19/2015] [Indexed: 11/16/2022]
Abstract
There are substantial differences in international guidelines for the management of pneumothorax and much geographical variation in clinical practice. These discrepancies have, in part, been driven by a paucity of high-quality evidence. Advances in diagnostic techniques have increasingly allowed the identification of lung abnormalities in patients previously labelled as having primary spontaneous pneumothorax, a group in whom recommended management differs from those with clinically apparent lung disease. Pathophysiological mechanisms underlying pneumothorax are now better understood and this may have implications for clinical management. Risk stratification of patients at baseline could help to identify subgroups at higher risk of recurrent pneumothorax who would benefit from early intervention to prevent recurrence. Further research into the roles of conservative management, Heimlich valves, digital air-leak monitoring, and pleurodesis at first presentation might lead to an increase in their use in the future.
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Affiliation(s)
- Oliver J Bintcliffe
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Rob J Hallifax
- Oxford Centre for Respiratory Medicine and Oxford NIHR Biomedical Research Centre, Churchill Hospital, Oxford, UK
| | - Anthony Edey
- Department of Radiology, North Bristol NHS Trust, Bristol, UK
| | | | - Y C Gary Lee
- Centre for Asthma, Allergy and Respiratory Research, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | | | | | | | - Najib M Rahman
- Oxford Centre for Respiratory Medicine and Oxford NIHR Biomedical Research Centre, Churchill Hospital, Oxford, UK
| | - Nick A Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
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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: 218] [Impact Index Per Article: 21.8] [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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22
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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: 23] [Impact Index Per Article: 2.3] [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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23
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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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Sihoe ADL, Yu PSY, Yeung JWL. Primary pneumothorax: Should surgery be offered after the first episode? World J Respirol 2015; 5:47-57. [DOI: 10.5320/wjr.v5.i1.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 01/01/2015] [Accepted: 02/02/2015] [Indexed: 02/06/2023] Open
Abstract
Surgery is the recommended and most effective means of preventing the recurrence of primary spontaneous pneumothorax (PSP). However, the conventional belief amongst most clinicians is that surgery should not be routinely offered to patients with an uncomplicated first episode of PSP. The view that surgery should be reserved for recurrent episodes of ipsilateral PSP is based on an apprehension regarding traumatic thoracic surgery combined with a perception that recurrences after a single episode of PSP are unlikely. Modern advances in minimally invasive thoracic surgery have now dramatically reduced the morbidity of PSP surgery. Such surgery is now safe, effective and causes minimal indisposition for patients. On the other hand, modern clinical data suggests that recurrence rate of PSP is perhaps much higher than previously assumed, with more than half of patients experiencing a second episode within several years of the first. With such new appreciations of the current situation, it is appropriate to now consider offering surgery to patients even after the first episode of PSP.
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Paliouras D, Barbetakis N, Lazaridis G, Baka S, Mpoukovinas I, Karavasilis V, Kioumis I, Pitsiou G, Papaiwannou A, Karavergou A, Lampaki S, Katsikogiannis N, Mpakas A, Tsakiridis K, Korantzis I, Fassiadis N, Zarogoulidis K, Zarogoulidis P. Video-assisted thoracic surgery and pneumothorax. J Thorac Dis 2015; 7:S56-61. [PMID: 25774310 DOI: 10.3978/j.issn.2072-1439.2015.01.35] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 01/09/2015] [Indexed: 12/12/2022]
Abstract
Video-assisted thoracoscopic surgery (VATS) is a type of thoracic surgery performed using a small video camera that is introduced into the patient's chest via a scope. It is considered a minimally invasive technique where the surgeon is able to view the instruments that are being used along with the anatomy on which the surgeon is operating. The camera and instruments are inserted through separate holes in the chest wall also known as "ports", depending on the patient and problem there are surgeries with one port "uniport", two or three ports. These small ports have the advantage that fewer infections are observed. This allows for a faster recovery. Traditionally, thoracic surgery performed for diagnosis or treatment of chest conditions has required access to the chest through thoracotomy or sternotomy incisions. Vats minimally invasive technique has replaced in many cases thoracotomy or sternotomy. In our current review we will present this technique in detail.
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Affiliation(s)
- Dimitrios Paliouras
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "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, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Nikolaos Barbetakis
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "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, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - George Lazaridis
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "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, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Sofia Baka
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "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, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Ioannis Mpoukovinas
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "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, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Vasilis Karavasilis
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "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, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Ioannis Kioumis
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "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, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Georgia Pitsiou
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "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, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Antonis Papaiwannou
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "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, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Anastasia Karavergou
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "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, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Sofia Lampaki
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "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, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Nikolaos Katsikogiannis
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "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, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Andreas Mpakas
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "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, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Kosmas Tsakiridis
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "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, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Ipokratis Korantzis
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "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, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Nikolaos Fassiadis
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "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, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Konstantinos Zarogoulidis
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "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, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
| | - Paul Zarogoulidis
- 1 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 Department of Oncology, "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, University General Hospital of Alexandroupolis, Alexandroupolis, Greece ; 7 Thoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 8 Oncology Department, "Saint Luke" Private Hospital, Thessaloniki, Greece ; 9 Vascular and Endovascular Surgeon, St. George's, King's College, Guy's and St Thoma' Hospitals, UK
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26
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Imperatori A, Rotolo N, Spagnoletti M, Festi L, Berizzi F, Di Natale D, Nardecchia E, Dominioni L. Risk factors for postoperative recurrence of spontaneous pneumothorax treated by video-assisted thoracoscopic surgery†. Interact Cardiovasc Thorac Surg 2015; 20:647-51; discussion 651-2. [PMID: 25690457 DOI: 10.1093/icvts/ivv022] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 01/14/2015] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES Over the past two decades, video-assisted thoracoscopic blebectomy and pleurodesis have been used as a safe and reliable option for treatment of spontaneous pneumothorax. The aim of this study is to evaluate the long-term outcome of video-assisted thoracoscopic surgery (VATS) treatment of spontaneous pneumothorax in young patients, and to identify risk factors for postoperative recurrence. METHODS We retrospectively analysed the outcome of VATS treatment of spontaneous pneumothorax in our institution in 150 consecutive young patients (age ≤ 40 years) in the years 1997-2010. Treatment consisted of stapling blebectomy and partial parietal pleurectomy. After excluding 16 patients lost to follow-up, in 134 cases [110 men, 24 women; mean age, 25 ± 7 standard deviation years; median follow-up, 79 months (range: 36-187 months)], we evaluated postoperative complications, focusing on pneumothorax recurrence, thoracic dysaesthesia and chronic chest pain. Risk factors for postoperative pneumothorax recurrence were analysed by logistic regression. RESULTS Of 134 treated patients, 3 (2.2%) required early reoperation (2 for bleeding; 1 for persistent air leaks). Postoperative (90-day) mortality was nil. Ipsilateral pneumothorax recurred in 8 cases (6.0%) [median time of recurrence, 43 months (range: 1-71 months)]. At univariate analysis, the recurrence rate was significantly higher in women (4/24) than in men (4/110; P = 0.026) and in patients with >7-day postoperative air leaks (P = 0.021). Multivariate analysis confirmed that pneumothorax recurrence correlated independently with prolonged air leaks (P = 0.037) and with female gender (P = 0.045). Chronic chest wall dysaesthesia was reported by 13 patients (9.7%). In 3 patients, (2.2%) chronic thoracic pain (analogical score >4) was recorded, but only 1 patient required analgesics more than once a month. CONCLUSIONS VATS blebectomy and parietal pleurectomy is a safe procedure for treatment of spontaneous pneumothorax in young patients, with a 6% long-term recurrence rate in our experience. Postoperative recurrence significantly correlates with female gender and with prolonged air leakage after surgery.
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Affiliation(s)
- Andrea Imperatori
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Nicola Rotolo
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Marco Spagnoletti
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Luigi Festi
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Fabio Berizzi
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Davide Di Natale
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Elisa Nardecchia
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Lorenzo Dominioni
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
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27
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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: 2.4] [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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28
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Lopez ME, Fallon SC, Lee TC, Rodriguez JR, Brandt ML, Mazziotti MV. Management of the pediatric spontaneous pneumothorax: is primary surgery the treatment of choice? Am J Surg 2014; 208:571-6. [DOI: 10.1016/j.amjsurg.2014.06.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 05/29/2014] [Accepted: 06/06/2014] [Indexed: 01/03/2023]
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Abstract
Pleural diseases encompass a vast and heterogeneous group of diseases that have traditionally received relatively little attention from researchers, resulting in empiric approaches to patient management based largely on expert opinions and anecdotal evidence. Yet, paradoxically, pleural diseases represent a considerable burden for patients, providers, and the healthcare system as a whole, with a rising incidence of malignant pleural effusions and pleural space infections, in increasingly complex patients. Fortunately, the last decade has witnessed unprecedented research efforts from the pleural community, which have resulted in substantial advances in risk-stratification, patient selection, treatment efficacy and the development of evidence-based recommendations ultimately leading to improved patient care. In this review, we will present a summary of the current evidence for the management of pleural diseases with an emphasis on interventional procedures, and highlight the need for future research efforts in the field of malignant pleural effusions, pleural space infections and pneumothorax.
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Affiliation(s)
- Zachary S DePew
- Division of Pulmonary and Critical Care Medicine, Gonda 18 South, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905, USA
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30
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Chau VWS, Patel P, Meghjee SPL. Simultaneous bilateral spontaneous pneumothoraces in a patient with occupational asthma. BMJ Case Rep 2013; 2013:bcr2013200080. [PMID: 24000212 PMCID: PMC3794145 DOI: 10.1136/bcr-2013-200080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Spontaneous pneumothoraces are relatively common; however, simultaneous bilateral spontaneous pneumothoraces (SBSP) have rarely been reported. This case report describes the presentation of SBSP in a 60-year-old man with occupational asthma. He was initially started on treatment for life-threatening asthma, but an early deterioration in symptoms prompted an urgent chest radiography that established the diagnosis of bilateral pneumothoraces. This was managed with bilateral needle thoracocentesis followed by stabilisation with intercostal chest drains. He was subsequently referred to the thoracic unit for minithoracotomy, bullectomy and talc pleurodesis. This case highlights the potential difficulties in diagnosing SBSP and advocates the necessity for prompt chest radiography when managing such presentations in the acute setting.
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Affiliation(s)
- Vincent Wing Sang Chau
- Department of Medicine, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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31
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Abstract
Quality of life (QOL) after medical interventions is paramount to the patient considering treatment recommendations. To understand QOL in thoracic surgery patients, one must examine the outcomes patients prioritize (preferences) from successful surgical therapy, overall functional status of thoracic surgery patients, the literature addressing QOL after thoracic surgery (TS) and the possible benefit of minimally invasive TS, and, finally, future directions of TS postoperative QOL research. The primary focus of this article is lung cancer surgery with mention of other thoracic disease such as empyema, pneumothorax, or emphysema, as well.
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Affiliation(s)
- John R Handy
- Providence Thoracic Oncology Program, Providence Cancer Center, North Tower, Portland, OR, USA.
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32
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Abstract
Pneumothoraces are classified as spontaneous, traumatic and iatrogenic. Spontaneous pneumothoraces that occur without recognized lung disease are termed primary spontaneous pneumothoraces (PSP), whereas those that occur due to an underlying lung disease are termed secondary spontaneous pneumothoraces. The aetiology of secondary, traumatic or iatrogenic pneumothoraces is not usually debated. However, the aetiology of PSP is potentially controversial and often debated. Therefore, PSP is the focus of this article. There are several purported causes, which include blebs, bullae, emphysema-like changes (ELC) and pleural porosity. The controversy is valid because of the importance of recurrence prevention. This article reviews the current available evidence for the causes of PSP. The causes of PSP are likely a combination ELC, pleural porosity and other potential factors.
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Affiliation(s)
- Demondes Haynes
- Division of Pulmonary and Critical Care Medicine, University of Mississippi Medical Center, Jackson, MS 39216-4505, USA.
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33
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Luh SP. Review: Diagnosis and treatment of primary spontaneous pneumothorax. J Zhejiang Univ Sci B 2011; 11:735-44. [PMID: 20872980 DOI: 10.1631/jzus.b1000131] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Primary spontaneous pneumothorax (PSP) commonly occurs in tall, thin, adolescent men. Though the pathogenesis of PSP has been gradually uncovered, there is still a lack of consensus in the diagnostic approach and treatment strategies for this disorder. Herein, the literature is reviewed concerning mechanisms and personal clinical experience with PSP. The chest computed tomography (CT) has been more commonly used than before to help understand the pathogenesis of PSP and plan further management strategies. The development of video-assisted thoracoscopic surgery (VATS) has changed the profiles of management strategies of PSP due to its minimal invasiveness and high effectiveness for patients with these diseases.
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Affiliation(s)
- Shi-ping Luh
- Department of Surgery, St. Martin de Porres Hospital, Chia-Yi City 60069, Taiwan, China.
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34
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Gygax-Genero M, Manen O, Chemsi M, Bisconte S, Dubourdieu D, Vacher A, Brocq FX, Leduc PA, Deroche J, Boussif M, Perrier E, Gourbat JP. [Treatment specifics for spontaneous pneumothorax in flight personnel]. REVUE DE PNEUMOLOGIE CLINIQUE 2010; 66:302-307. [PMID: 21087725 DOI: 10.1016/j.pneumo.2010.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Accepted: 06/24/2010] [Indexed: 05/30/2023]
Abstract
Spontaneous pneumothorax is one cause of aeronautical unfitness in flight personnel, because of the risk of recurrence in flight, making it an issue of flight safety. Specific treatment is required for fighter pilots, pilots flying single-pilot and pilots in professional training: surgical synthesis via video-thoracoscopy is obligatory from the first episode. Considering the exposure to an accumulation of aeronautical factors that are likely to encourage pneumothorax recurrence in flight, it is apical pleurectomy together with abrasion of the remaining pleura and resection of bullae/blebs that is required for fighter pilots to allow them to recover aeronautical fitness unrestrictedly. For all other categories of flight personnel, treatment is no different from that of the common patient. Knowledge of these treatment specifics is essential, to avoid unnecessary systematic surgical indication for all flight personnel, or jeopardise professional fitness in some of them due to inappropriate treatment.
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Affiliation(s)
- M Gygax-Genero
- Centre principal d'expertise médicale du personnel navigant, hôpital d'instruction des armées Percy, Ilôt Percy, Clamart, France.
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35
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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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Mun SH, Jang IS, Lee CE, Kim JW, Choi JY, Rhie SH. Thoracoscopic Bleb Ligation in Patients with Primary Spontaneous Pneumothorax. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2010. [DOI: 10.5090/kjtcs.2010.43.2.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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37
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Abstract
Minimally invasive thoracic surgery (MITS) has become part of the modern thoracic surgeon's armamentarium. Its applications include diagnostic and therapeutic procedures, and over the past one and a half decades, the scope of MITS has undergone rapid evolution. The role of MITS is well established in the management of pleural and mediastinal conditions, and it is beginning to move beyond diagnostic procedures for lung parenchyma conditions, to gain acceptance as a viable option for primary lung cancer treatment. However MITS poses technical challenges that are quite different from the conventional open surgical procedures. After a brief review of the history of MITS, an overview of the scope of MITS is given. Important examples of diagnostic and therapeutic indications are then discussed, with special emphasis on the potential complications specific to MITS, and their prevention and management.
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Affiliation(s)
- Michael K Y Hsin
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
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38
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Robinson PD, Cooper P, Ranganathan SC. Evidence-based management of paediatric primary spontaneous pneumothorax. Paediatr Respir Rev 2009; 10:110-7; quiz 117. [PMID: 19651381 DOI: 10.1016/j.prrv.2008.12.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The exact incidence of paediatric primary spontaneous pneumothorax (PSP) is unclear, although PSP incidence in the general population is between 6 and 18 per 100,000. PSP has been reported throughout the paediatric age range. A potential genetic predisposition for familial cases has been recently identified. Whilst there is universal consensus on the management of tension pneumothorax, lack of agreement and consistency exists across a wide range of management issues for other aspects of PSP management. Paediatric PSP may have a higher recurrence rate than adult PSP, and the presence of apical lung cysts or bullae is not predictive of recurrence. The decision for surgical intervention should be based on documented recurrence. There is a lack of paediatric evidence to guide management decisions, and extrapolation of predominantly adult data to younger age groups should not be encouraged. Given the relatively low apparent incidence, a multicentre approach to future research is required in order to generate the evidence required for informed management of PSP in children.
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Affiliation(s)
- Paul D Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, NSW, 2145 Australia.
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