ObjectiveTo explore clinical outcomes of simutaneous video-assisted thoracoscopic surgery (VATS) for bilateral giant bullae (GB).
MethodsClinical data of 160 GB patients who received surgical treatment in the First Affiliated Hospital of Xinjiang Medical University from March 2011 to April 2013 were retrospectively analyzed. According to GB location and surgical strategies, all the patients were divided into 3 groups. In group A, there were 108 patients with spontaneous pneumothorax (SP) and unilateral GB who underwent unilateral GB resection with VATS, including 88 male and 20 female patients with their age of 31.36±16.14 years. In group B, there were 40 patients with SP and bilateral GB who underwent unilateral GB resection in the SP side with VATS, including 36 male and 4 female patients with their age of 37.63±18.84 years. In group C, there were 12 patients with SP and bilateral GB who underwent simultaneous bilateral GB resection with VATS, including 9 male and 3 female patients with their age of 32.58±16.06 years. Postoperative morbidity and SP recurrence rates were analyzed.
ResultsAll the operations were successfully performed, and patients were followed up for 20 months after discharge. In group A, postoperative complications included acute pulmonary edema in 1 patient, pleural adhesion in 11 patients, respiratory failure in 2 patients, and pulmonary air leak in 5 patients. During follow-up, SP recurred in 5 patients including 2 patients with SP recurrence at the same side and 3 patients with SP recurrence at the other side of thorax. In group B, postoperative complications included pleural adhesion in 4 patients, respiratory failure in 1 patient, and pulmonary air leak in 3 patients. During follow-up, SP recurred in 18 patients including 3 patients with SP recurrence at the same side and 15 patients with SP recurrence at the other side of thorax. In group C, postoperative complications included pleural adhesion in 2 patients and pulmonary air leak in 1 patient. During follow-up, SP recurred in 1 patient at the same side of thorax. SP recurrence rates of group A and C were significantly lower than that of group B (P=0.000 and P=0.031 respectively).
ConclusionSimultaneous VATS is safe, efficacious and reliable for the treatment of bilateral GB, and can effectively prevent SP recurrence at the other side of thorax.
ObjectiveTo explore the surgical procedures for primary spontaneous pneumothorax without bullae.
MethodsWe retrospectively analyzed the clinical data of 52 patients with primary spontaneous pneumothorax without bullae, who underwent surgical treatment in Second Affiliated Hospital of Kunming Medical University between January 2008 and January 2013. There were 46 males and 6 females, with mean average age of 23.2±4.3 years (ranged from 16 to 34 years). According to the different methods of intraoperative surgery, all patients were divided into three groups. The patients in a group Ⅰ (n=20) underwent video-assisted thoracoscope (VATS) selective apex of low energy electric coagulation treatment. The patients in a group Ⅱ (n=21) underwent VATS lung tip part of lung resection. The patients in a group Ⅲ (n=11) received VATS resection of the pleura. The clinical effectiveness among the three groups was compared.
ResultsCompared with other two kinds of operation schemes,the leak duration(2.61±1.89 d vs. 4.90±3.20 d vs. 5.36±2.57 d, P=0.012), postoperative chest tube drainage time (3.67±2.13 d vs. 6.00±3.73 d vs. 7.03±2.58 d, P=0.003), postoperative length of hospital stay (4.95±2.16 d vs. 7.35±3.03 d vs. 8.61±2.67 d, P=0.002) and the recurrence rate (0.0% vs. 23.1% vs. 12.5%, P=0.021) of the patients with lung tip part resection of lung tissue by VATS were significantly lower. There were no statistically significant differences in the indicators of the patients with selective apex of low energy electric coagulation by VATS and those with pleural resection by VATS (P>0.05).
ConclusionLung tip part of the lung tissue resection by VATS for primary spontaneous pneumothorax without bullae is better than VATS selective apical low energy coagulation treatment and VATS resection of the pleura both in the short and long-term efficacy.
Objective To evaluate the incidence and characteristics of spontaneous pneumothorax in patients with Marfan syndrome (MFS), and to analyze its related factors. Methods The medical record of patients with MFS who were hospitalized in the First Affiliated Hospital of University of Science and Technology of China from March 1, 2017 to December 31, 2022 were retrospectively collected, to analyze the incidence of pneumothorax and related risk factors. Results A total of 53 patients (including 29 males, 55%) were included, with a median age of 32 years (ranging from 13 to 65 years). All patients denied family history of pneumothorax. Four cases (8%) had one episode of spontaneous pneumothorax, with pulmonary bullae involved the ipsilateral apex. Among them, 3 cases (75%) had single pulmonary bulla and thoracic deformity. Of the 49 patients without previous pneumothorax history, 9 (18%) had pulmonary bullae, of which 6 (67%) were located at the apex of the lung, and the remaining 3 (33%) were in the middle and lower lobes of the lung; In addition, 6 cases (12%) were coexisted with thoracic deformity. The incidence of pneumothorax in patients with pulmonary bullae in MFS was significantly higher than those without pulmonary bullae (31% vs. 0%, P=0.002), and the incidence of pneumothorax in patients with thoracic deformities was significantly higher than those with normal thorax (33% vs. 2%, P=0.013). Of the 4 patients with pneumothorax, 2 underwent bullectomy, 1 underwent thoracic drainage, and the other underwent thoracic puncture and aspiration procedures, respectively. No recurrence of pneumothorax was observed during the follow-up period. Sixteen cases of MFS with spontaneous pneumothorax (11 males, 69%) were reported in Chinese literature, with a median age of 17 years (ranging from 13 to 28 years). Among them, 3 cases (19%) had a family history of pneumothorax, and 14 cases (88%) had thoracic deformities. Bullae was found in all 5 patients with pneumothorax, 4 of them with chest CT images involved the ipsilateral upper lobe. Forty-four percents of 16 patients had pneumothorax recurrence. Conclusions The incidence of MFS complicated with spontaneous pneumothorax is significantly higher. However, most of them have no family history of pneumothorax. The incidence of pneumothorax with MFS is associated with pulmonary bullae (especially the apex of lung) and thoracic deformity. Timely surgical intervention should be carried out when pneumothorax happened.
ObjectiveTo explore the safety, feasibility and superiority of tubeless video-assisted thoracoscopic surgery (VATS) in the treatment of spontaneous pneumothorax.MethodsWe retrospectively analyzed the clinical data of 38 patients with primary spontaneous pneumothorax treated in our hospital from February 2017 to July 2018. Tubeless bullectomy was performed in 18 patients, including 11 males and 7 females, aged 14.3±1.5 years. Twenty patients underwent conventional thoracoscopic bullae resection, including 12 males and 8 females, aged 14.5±1.7 years. The clinical effectiveness was compared.ResultsAll the 38 patients completed the operation successfully under the single-port thoracoscopy, without the transfer of intubation and secondary surgery. Operation time (67.3±13.3 min vs. 81.4±13.4 min, P=0.002), preoperative anesthesia time (14.2±2.6 min vs. 18.5±2.6 min, P=0.000), postoperative anesthesia recovery time (17.1±2.6 min vs. 26.5±5.0 min, P=0.000), visual simulation score of postoperative pain (2.3±0.9 vs. 5.2±1.0, P=0.000), postoperative activity time (1.3±0.4 d vs. 2.9±0.6 d, P=0.000), postoperative hospitalization time (2.9±0.8 d vs. 5.6±1.3 d, P=0.000), hospitalization cost (35.0±6.0 kyuan vs. 59.0±10.0 kyuan, P=0.000) were better in the control group. There was no significant difference in intraoperative blood loss (73.2±4.6 mL vs. 73.9±4.1 mL) and postoperative lung revascularization time (29.3±2.4 h vs. 29.7±2.5 h) between the two groups (P>0.05).ConclusionCompared with traditional thoracoscopic bullectomy, tubeless VATS technique is safe and reliable in the treatment of spontaneous pneumothorax, with mild pain and quick recovery, in line with the concept of fast track surgery and worthy of clinical promotion.
ObjectiveTo evaluate the efficacy, safety, and long-term recurrence rate of thoracoscopic bullae resection combined with parietal pleurectomy or pleural abrasion for the treatment of spontaneous pneumothorax. MethodsRelevant literatures were searched in PubMed, Web of Science, EMbase, The Cochrane Library, CNKI, Wanfang and VIP databases from the establishment of each database to February 1, 2025. According to the inclusion and exclusion criteria, the literatures were screened. Meta-analysis was conducted using Review Manager 5.3 software, and the quality of the literatures was evaluated using the Cochrane Bias Risk Assessment Tool and the NOS scale. ResultsA total of 23 articles were included, including 6 randomized controlled studies and 17 retrospective cohort studies, with NOS scores≥7. A total of 3 296 patients were enrolled, including 1 245 in the parietal pleurectomy group and 2 051 in the pleural abrasion group. The meta-analysis results showed that the pleural abrasion group had shorter operation time [MD=19.68, 95%CI (14.12-25.25)], less intraoperative blood loss [MD=11.31, 95%CI (4.20-18.41)], lower postoperative pain score [MD=0.48, 95%CI (0.04-0.91)], lower total postoperative drainage volume [MD=44.31, 95%CI (11.92-76.71)], shorter postoperative drainage time [MD=0.32, 95%CI (0.03-0.60)], and shorter hospital stay [MD=0.40, 95%CI (0.23-0.57)] compared with the parietal pleurectomy group, and the differences were statistically significant (P<0.05). In terms of safety, the parietal pleurectomy group increased the incidence of postoperative pulmonary hemorrhage [OR=3.99, 95%CI (1.49-10.65), P<0.05], but there were no statistically significant differences in the incidence of postoperative atelectasis, pneumothorax leakage and pulmonary infection (P>0.05). In addition, the parietal pleurectomy group could effectively reduce the long-term recurrence rate of patients [OR=0.48, 95%CI (0.36-0.64)], and the difference was statistically significant (P<0.05). ConclusionDecortication inevitably imposes a greater perioperative burden on patients with spontaneous pneumothorax and pulmonary bullae, yet it effectively reduces the risk of postoperative recurrence. While both surgical approaches exhibit similar safety profiles, parietal pleurectomy may elevate the risk of postoperative pulmonary hemorrhage. Therefore, the optimal treatment strategy should be determined based on individual patient characteristics.
ObjectiveTo systematically evaluate the effectiveness and safety of single-incision video-assisted thoracic surgery (VATS) versus conventional three-port VATS for primary spontaneous pneumothorax.
MethodsWe searched databases including PubMed, EMbase, The Cochrane Library, CBM, CNKI and WanFang Data from inception to Dec. 2014, to collect randomized controlled trials (RCTs) and cohort studies comparing single-incision VATS and conventional three-port VATS for primary spontaneous pneumothorax. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, RevMan 5.3 software was used for meta-analysis.
ResultsA total of 8 cohort studies involving 483 patients were finally included. The results of meta-analysis showed that:Compared with conventional three-port VATS, single-incision VATS had shorter operation time (MD=-3.90, 95%CI -7.22 to -0.58, P=0.02), less amount of intraoperative bleeding (MD=-9.34, 95%CI -15.26 to -3.42, P=0.002), shorter chest drainage time (MD=-0.66, 95%CI -1.02 to -0.29, P=0.000 4), lower VAS score of 24h-postoperative pain (MD=-0.90, 95%CI -1.14 to -0.66, P<0.000 01) and lower incidence of postoperative paresthesia (OR=0.15, 95% CI 0.07 to 0.31, P<0.000 01). Meanwhile, there were no statistical differences between both groups in hospital stay (MD=-0.30, 95%CI -0.63 to 0.03, P=0.08) and the recurrence of pneumothorax (OR=0.68, 95%CI 0.25 to 1.83, P=0.53).
ConclusionCurrent evidence shows, single-incision VATS is superior to conventional three-port VATS in the treatment of spontaneous pneumothorax. However, due to limited quality and quantity of included studies, more large-scale, high-quality studies are needed to verify the above conclusion.
Surgical treatment is an important treatment for spontaneous pneumothorax, which can remove the gas in the pleural cavity, relieve symptoms, promote lung recruitment, moreover, prevent future recurrence. The surgical modalities included video-assisted thoracoscopic surgery (VATS) and non VATS treatment. Nowadays, the treatment of spontaneous pneumothorax has entered a minimally invasive era. With the development of minimally invasive techniques in recent years, as the representative of minimally invasive surgery, the surgeon techniques of VATS has developed to diversity, including three-port VATS, two-port VATS, uniportal VATS, subxiphoid uniportal VATS, 3D VATS, robotic-assisted VAT and cervical uniportal VATS. Each technique has its own advantages and limitations, and individual choices should be made.
Objective To systematically evaluate the efficacy and safety of single-port thoracoscopic surgery (SPTS) in the treatment of spontaneous pneumothorax. Methods Computer searches were conducted in PubMed, The Cochrane Library, Web of Science, EMbase, CNKI, WanFang, and the Chinese Medical Association databases to collect randomized controlled trials (RCTs) and cohort studies on the comparison of efficacy and safety of SPTS and three-port thoracoscopic surgery (TPTS) for the treatment of spontaneous pneumothorax from their inception to March 2024. The Cochrane RCT bias risk assessment tool and the Newcastle-Ottawa Scale (NOS) were used to assess the quality of RCT and cohort study, respectively. Meta-analysis was performed using RevMan 5.4.1. ResultsA total of 68 studies were included, comprising 23 RCTs and 45 cohort studies with a total of 5403 patients. The NOS scores of the cohort studies were 7-8 points. Meta-analysis results showed that compared with TPTS, SPTS had less intraoperative blood loss [SMD=?1.58, 95%CI (?1.93, ?1.22), P<0.001], shorter postoperative hospital stay [SMD=?1.05, 95%CI (?1.29, ?0.82), P<0.001], shorter postoperative drainage tube placement time [SMD=?0.75, 95%CI (?1.00, ?0.50), P<0.001], fewer postoperative complications [OR=0.34, 95%CI (0.26, 0.45), P<0.001], fewer postoperative recurrences [OR=0.48, 95%CI (0.32, 0.72), P<0.001], and less pain at 24, 48, and 72 h postoperatively [SMD=?1.71, 95%CI (?2.13, ?1.30), P<0.001; SMD=?1.70, 95%CI (?2.35, ?1.06), P<0.001; SMD=?1.72, 95%CI (?2.16, ?1.29), P<0.001]. Conclusion SPTS is safe and effective in the treatment of spontaneous pneumothorax with high clinical value and can be further promoted in clinical practice. Considering the limitations in the number and quality of included studies, researches with larger sample sizes and higher quality are needed to validate the above conclusions.
ObjectiveTo analyze the occurrence of postoperative pulmonary complications (PPC) and the risk factors in patients with spontaneous pneumothorax who underwent micro single-port video-assisted thoracoscopic surgery (VATS).MethodsA total of 158 patients with spontaneous pneumothorax who underwent micro single-port VATS in our hospital from April 2017 to December 2019 were retrospectively included, including 99 males and 59 females, with an average age of 40.53±9.97 years. The patients were divided into a PPC group (n=21) and a non-PPC group (n=137) according to whether PPC occurred after the operation, and the risk factors for the occurrence of PPC were analyzed.ResultsAll 158 patients successfully completed the micro single-port VATS, and there was no intraoperative death. The postoperative chest tightness, chest pain, and dyspnea symptoms basically disappeared. During the postoperative period, there were 3 patients of pulmonary infection, 7 patients of atelectasis, 4 patients of pulmonary leak, 6 patients of pleural effusion, 1 patient of atelectasis and pleural effusion, and the incidence of PPC was 13.29% (21/158). Multivariate logistic regression analysis showed that lung disease [OR=32.404, 95%CI (2.717, 386.452), P=0.006], preoperative albumin level≤35 g/L [OR=14.912, 95%CI (1.719, 129.353), P=0.014], severe pleural adhesions [OR=26.023, 95%CI (3.294, 205.557), P=0.002], pain grade Ⅱ-Ⅲ 24 hours after the surgery [OR=64.024, 95%CI (3.606, 1 136.677), P=0.005] , age [OR=1.195, 95%CI (1.065, 1.342), P=0.002], intraoperative blood loss [OR=1.087, 95%CI (1.018, 1.162), P=0.013] were the risk factors for PPC after micro single-port VATS.ConclusionThere is a close relationship between PPC after micro single-port VATS and perioperative indexes in patients with spontaneous pneumothorax. Clinically, targeted prevention and treatment can be implemented according to the age, pulmonary disease, preoperative albumin level, intraoperative blood loss, degree of pleural adhesion and pain grading 24 hours after surgery.
