When is video-assisted thoracoscopic surgery (VATS) indicated for treatment of pneumothorax?

Updated: Apr 28, 2020
  • Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Video-assisted thoracoscopic surgery (VATS) is chosen for recurrent primary (PSP) or secondary spontaneous pneumothorax (SSP), particularly for pediatric patients, in whom it has been shown to have better outcomes and shorter recovery. VATS is an alternative to thoracotomy and is performed with the patient under general anesthesia using a camera and small trocar access ports. Other indications include an unexpanded lung 5 days after tube thoracostomy, bronchopleural fistula persisting for 5 days or longer, recurrent pneumothorax after chemical pleurodesis, and occupational reasons (eg, airplane pilots, deep-sea divers).

In a meta-analysis of 12 trials that randomized 670 patients, VATS was associated with shorter length of stay (reduction, 1.0-4.2 days) and less pain or use of pain medication than thoracotomy in the five of seven trials in which the technique was used for pneumothorax or minor lung resection. [69]  In the treatment of pneumothorax, VATS was associated with substantially fewer recurrences than pleural drainage in two trials. [69] VATS with resection of large bullous lesions is associated with a recurrence rate of 2-14%.

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