Two-port versus three-port video-assisted thoracoscopic surgery for primary spontaneous pneumothorax: feasibility, postoperative outcome and long-term recurrence rates

Abstract

Background Two-port VATS (2-P-VATS) and three-port VATS (3-P-VATS) are well-established techniques for surgical therapy of primary spontaneous pneumothorax (PSP). However, comparisons of both techniques in terms of postoperative outcome and recurrence are limited. Methods From January 2010 to March 2020, we retrospectively reviewed data of 58 PSP patients who underwent VATS in our institution. For statistical analysis, categorical and continuous variables were compared by chi-square test or Fisher’s exact test and the Student´s t-test, respectively. Twenty-eight patients underwent 2-P-VATS and 30 were treated with 3-P-VATS. Operation time, length of hospital stay (LOS), total dose of analgesics per stay (opioids and non-opioids), duration of chest tube drainage, pleurectomy volume (PV), postoperative complications and recurrence rates were compared between both groups. Results Clinical and surgical characteristics including mean age, gender, Body-Mass-Index (BMI), pneumothorax size, smoking behaviour, history of contralateral pneumothorax, side of pneumothorax, pleurectomy volume and number of resected segments were similar in both groups. The mean operation time, LOS and total postoperative opioid and non-opioid dose was significantly higher in the 3-P-VATS group compared with the 2-P-VATS group. Despite not being statistically significant, duration of chest tube was longer in the 3-P-VATS group compared with the 2-P-VATS group. In terms of postoperative complications, the occurrence of hemothorax was significantly higher in the 3-P-VATS group (3-P-VATS vs. 2-P-VATS; p = 0.001). During a median follow-up period of 61.6 months, there was no significant statistical difference in recurrence rates in both groups (2/28 (16.7%) vs. 5/30 (7.1%); p = 0.274). Conclusion Our data demonstrate that 2-P-VATS is safer and effective. It is associated with reduced length of hospital stay and decreased postoperative pain resulting in less analgesic use.

Postoperative Pain and Clinical Outcome Following Two- and Three-Port Video-Assisted Thoracoscopic Surgery for Secondary Spontaneous Pneumothorax

“…In the last decade, thoracic surgery has evolved from open thoracotomy to video-assisted thoracoscopic surgery (VATS), as the gold standard. While three-port VATS (3P-VATS) still remains the standard of care in most centers, due to its accessibility, recent surgical and technical developments are leading to a reduction in access ports [ 7 ]. While there are abundant reports on the surgical performance and benefits of limited port access, in terms of postoperative pain, paresthesia and length of hospital stay (LOS), for the treatment of primary spontaneous pneumothorax (PSP) [ 8 , 9 , 10 , 11 , 12 , 14 ], there is a lack of information on VATS for the treatment of SSP in such reports.…”

“…The 3P-VATS was performed as previously described [ 7 ]. Briefly, three 11 mm ports were placed at the level of the 5th intercostal space in the anterior axillary line and at the level of the 7th and 8th intercostal spaces in the mid- and posterior axillary lines, respectively.…”

“…The 2P-VATS was also performed as previously described [ 7 ]. In summary, two 11 mm ports were inserted at the level of the 5th and 8th intercostal space in the mid- and anterior axillary lines, respectively.…”

“…In summary, two 11 mm ports were inserted at the level of the 5th and 8th intercostal space in the mid- and anterior axillary lines, respectively. For bullectomy, an endograsper and endoscopic stapling device were inserted side by side, without trocar guidance, via the incision in the 5th intercostal space [ 7 ] ( Figure 2 ).…”

“…The high rates of morbidity depend not only on the underlying pulmonary disease, but also on the surgical technique used. Regarding the treatment of primary spontaneous pneumothorax (PSP), recent studies have reported low morbidity rates and less postoperative pain when using a low number of access ports for VATS [ 7 , 8 , 9 , 10 , 11 , 12 ]. Although, nowadays, three-port (3P) and two-port (2P) VATS are well-established surgical techniques for the treatment of complicated SP; a comparison between both techniques, in terms of postoperative outcome following SSP treatment, is unreported.…”