Thoracoscopic Bilateral Bullectomy for Simultaneously Developed Bilateral Primary Spontaneous Pneumothorax: Ipsilateral Transmediastinal versus Bilateral Sequential Approach

Abstract

Simultaneously developed bilateral primary spontaneous pneumothorax (BPSP) is an indication for thoracic surgery of both sides. Recently, we have reported a new technique for BPSP, which is ipsilateral apicoposterior transmediastinal (TM) bullectomy of both sides using video-assisted thoracoscopic surgery (VATS), and we compared this TM VATS with bilateral sequential (BS) VATS for BPSP. From June 2003 to May 2014, 11 and 14 patients were performed VATS TM and BS bullectomy for BPSP, respectively. We reviewed the medical records and compared the clinical data between the two groups. For TM group, we first performed the right VATS bullectomy and approached through the apicoposterior mediastinal region for contralateral VATS. In the other group, conventional BS VATS bullectomy was performed in the lateral decubitus position change. The mean follow-up was 62.0 ± 32.6 months. No mortality and major complications were observed. The operative time (68.18 ± 24.93 vs. 96.07 ± 37.73, = 0.046), duration of left pleural drainage (1.00 ± 0.45 vs. 3.21 ± 1.37, = 0.000), and length of hospital stay (3.82 ± 1.54 vs. 4.93 ± 1.07, = 0.044) were significantly shorter in the TM group than in the BS group. No significant differences were seen in duration of general anesthesia, total number of wedge resections and endostaplers used in both lungs, duration of right drainage, and postoperative recurrence. The TM VATS approach may be a safe and feasible modality for BPSP. It may decrease the operative time, patients inconvenience such as bilateral multiple wounds and longstanding placement of chest tubes, and decrease the hospital stay compared with the BS VATS approach.

Simultaneous Bilateral Primary Spontaneous Pneumothorax: A Case Report and a Review of the Literature

“…Lee et al performed bilateral VATS in 13 patients with SBPSP and reported 2 (7.7%) recurrence episodes [12]. However, the study by Cho et al, which reported the most cases of SBPSP, found the recurrence rate to be as high as 44% [7]. In this study, Cho et al performed ipsilateral transmediastinal approach VATS in approximately half of the patients and traditional bilateral sequential approach in the other half.…”

“…For patients who underwent bilateral VATS, the overall recurrence rate was 27.3%. However, it is important to note that the number is largely influenced by one relatively large study by Cho et al that showed the recurrence rate of 44% [7]. All included studies are summarized in Table 2.…”