Elective Videothoracoscopy – A Tool for Prevention of Primary Spontaneous Pneumothorax?

Česká verzia

Authors: J. Vodička; V. Špidlen; J. Ferda ¹ ; P. Mukenšnabl ²; J. Šafránek; V. Šimánek
Authors place of work: Chirurgická klinika Lékařské fakulty Univerzity Karlovy a Fakultní nemocnice v Plzni přednosta prof. MUDr. V. Třeška, DrSc. ; Radiodiagnostická klinika Lékařské fakulty Univerzity Karlovy a Fakultní nemocnice v Plzni přednosta doc. MUDr. B. Kreuzberg, CSc. ¹; Šiklův patologicko-anatomický ústav Lékařské fakulty Univerzity Karlovy a Fakultní nemocnice v Plzni přednosta prof. MUDr. M. Michal ²
Published in the journal: Rozhl. Chir., 2008, roč. 87, č. 5, s. 228-232.
Category: Monothematic special - Original

Summary

Aim:
Based on the retrospective analysis of the selected group of patients with primary spontaneous pneumothorax (PSP), the authors aim to demonstrate contribution of CT scan examinations and elective videothoracoscopic procedures in diagnostics and treatment of pulmonary conditions, predisposing the patient to the disorder.

Material and Methodology:
During 2005–2007, 45 patients with PSPs underwent post- treatment CT lung examinations. Pathological findings potentially resulting in collapsed lung, were detected in nearly 25% of the subjects. All of the subjects (males, the mean age of 22.4 years) were then indicated for elective videothoracoscopy, in order to prevent potential PSP events. The procedure included peripheral endostapler lung lesion resection and mechanical pleurodesis (pleuroabrasion), resp. partial apical pleurectomy.

Results:
Pathological changes of the lung tissue were detected with the same rate in the both, right and left lung apices. In miniinvasive procedures, they were always easily located, as anticipated. In all of the subjects, the changed tissue was removed using peripheral lung resections, with concomittant pleuroabrasion in a half of the subjects, while in the other half of the subject, the procedure was combined with partial apical pleurectomy. Intraoperative morbidity and mortality were nil. The mean period of postoperative drainage was 5.5 days, the mean duration of hospitalization was a week. During the study period, no further PSP events were recorded.

Conclusion:
CT examination-based detection of pneumothorax-predisposing pathological lung tissue changes and their subsequent removal using elective videothoracoscopy, is a valid and a patient-beneficial procedure.

Key words:
primary spontaneous pneumotorax – CT examination – elective videothoracoscopy

Zdroje

1. Gómez-Caro, A., Moradiellos, F. J., Larrú, E., Díaz-Hellín, V., Marrón, C., Pérez-Antón, J. A., Martín de Nicolás, J. L. Effectiveness and complications of video-assisted surgery for primary spontaneous pneumothorax. Arch. Bronconeumol., 2006, roč. 42, č. 2, s. 57–61.

2. Hirai, S., Hamanaka, Y., Mitsui, N., Morifuji, K., Uegami, S., Matsuura, Y. Therapeutic strategy for spontaneous pneumothorax. Kyobu Geka, 2007, roč. 60, č. 3, s. 175–179.

3. Tschopp, J. M., Frank, W., Noppen, M. The management of spontaneous pneumothorax. Pneumologie, 2005, roč. 59, č. 12, s. 879–889.

4. Lang-Lazdunski, L., de Kerangal, X., Pons, F., Jancovici, R. Primary spontaneous pneumothorax: one-stage treatment by bilateral videothoracoscopy. Ann. Thorac. Surg., 2000, roč. 70, č. 2, s. 412–417.

5. Pearson, F. G., Cooper, J. D., Deslauriers, J., Ginsberg, R. J., Hiebert, C. A., Patterson, G. A., Urschel J. R. Thoracic Surgery. Second Edition. Philadelphia: Churchill Livingstone, 2002. 1942 s.

6. Suter, M., Berner, M., Vandoni, R., et al. Traitement par thoracoscopie du pneumothorax récidivant. Helv. chir. Acta, 1994, roč. 60, č. 4, s. 465–470.

7. Way, L. W., a kol. Současná chirurgická diagnostika a léčba. Praha: Grada Publishing, 1998. 1660 s.

8. Čapov, I. Videoasistovaná torakoskopie a její význam v léčbě spontánního pneumotoraxu. Habilitační práce. Brno: Masarykova univerzita, 1998.

9. Janík, M., Belák, J., Sauka, C., Morochovič, R. Spontánny pneumotorax. Niekolko aktuálnych pohladov. Rozhl. Chir., 1999, roč. 78, č. 3, s. 120–122.

10. Noppen, M., Alexander, P., Driesen, P., Slabbynck, H., Verstraeten, A. Manual aspiration versus chest tube drainage in first episodes of primary spontaneous pneumothorax: a multicenter, prospective, randomized pilot study. Am. J. Respir. Crit. Care Med., 2002, roč. 165, č. 9, s. 1240–1244.

11. Rindoš, R., Hamžík, J., Láska, M., Vrastyák, J. Spontánny pneumotorax – súčasný pohlad na liečbu. Rozhl. Chir., 1994, roč. 73, č. 7, s. 335–338.

12. Rybka, J., a spol. Kritické stavy vnitřního lékařství ve všeobecné praxi. Praha: Avicenum, 1992. 392 s.

13. Sayer, A., Turna, A., Metin, M., Kucukyagci, N., Solak, O., Gurses, A. Simultaneous bilateral spontaneous pneumothorax: report of 12 cases and review of the literature. Acta Chir. Belg., 2004, roč. 104, č. 5, s. 572–576.

14. Ayed, A. K. Bilateral video-assisted thoracoscopic surgery for bilateral spontaneous pneumothorax. Chest, 2002, roč. 122, č. 6, s. 2234–2237.

15. Maruyama, R., Anai, H. Video-assisted thoracoscopic surgery for bilateral spontaneous pneumothorax in supine position: the use of a pillow beneath the back for intercostal space widening. Thorac. Cardiovasc. Surg., 2000, roč. 48, č. 6, s. 370–371.

16. Rivo Vazquez, J.E., Canizares Carretero, M. A., Garcia Fontan, E., Aabort Ventura, J., Penalver Pascual, R. Surgical treatment of recurrent spontaneous pneumothorax: what is the optimal timing? Arch. Bronconeumol., 2004, roč. 40, č. 6, s. 275–278.

17. Komarov, R. N., Gorshkov, V. I., Komarov, N. V. Strategy of treatment of patients with recurrent spontaneous pneumothorax: is active surgical treatment necessary? Vestn. Khir. Im. I I Grek., 2005, roč. 164, č. 5, s. 23–25.

18. Ouanes-Besbes, L., Golli, M., Knani, J., Dachraoui, F., Nciri, N., El Atrous, S., Gannouni, A., Abroug, F. Prediction of recurrent spontaneous pneumothorax: CT scan findings versus management features. Respir. Med., 2007, roč. 101, č. 2, s. 230–236.

19. Sihoe, A. D., Yim, A. P., Lee, T. W., Wan, S., Yuen, E. H., Wan, I. Y., Arifi, A. A. Can CT scanning be used to select patients with unilateral primary spontaneous pneumothorax for bilateral surgery? Chest, 2000, roč. 118, č. 2, s. 380–383.

20. Choudhary, A. K., Sellars, M. E., Wallis, C., Cohen, G., Mchugh, K. Primary spontaneous pneumothorax in children: the role of CT in guiding management. Clin. Radiol., 2005, roč. 60, č. 4, s. 508–511.

21. Kruger, M., Ermitsch, M., Uschinsky, K., Engelmann, C. Results of video-assisted thoracoscopic surgery for pneumothorax. Zentralbl. Chir., 2003, roč. 128, č. 8, s. 645–651.

22. Naunheim, K. S., Mack, M. J., Hazelrigg, S. R., Ferguson, M. K., Ferson, P. F., et al. Safety and efficacy of video-assisted thoracic surgical techniques for the treatment of spontaneous pneumothorax. J. Thorac. Cardiovasc. Surg., 1995, roč. 109, č. 6, s. 1198–1204.

23. Fernandez, M. I., Martin-Ucar, A. E., Lee, H. D., West, K. J., Wyatt, R., Waller, D. A. Does a thoracic epidural confer any additional benefit following video-assisted thoracoscopic pleurectomy for primary spontaneous pneumothorax? Eur. J. Cardiothorac. Surg., 2005, roč. 27, č. 4, s. 671–674.

24. Chang, Y. C., Chen, C. W., Huang, S. H., Chen, J. S. Modified needlescopic video-assisted thoracic surgery for primary spontaneous pneumothorax: the long-term effects of apical pleurectomy versus pleural abrasion. Surg. Endosc., 2006, roč. 20, č. 5, s. 757–762.

25. Santillán-Doherty, P., Argote-Greene, L. M., Guzman-Sanchez, M. Thoracoscopic management of primary spontaneous pneumothorax. Am. Surg., 2006, roč. 72, č. 2, s. 145–149.

26. Zisis, C., Stratakos, G. Do we know the ideal surgical treatment for primary spontaneous pneumothorax? Eur. J. Cardiothorac. Surg., 2006, roč. 29, č. 6, s. 1067.

27. Sihoe, A. D., Au, S. S., Cheung, M. L., Chow, I. K., Chu, K. M., Law, C. Y., Wan, M., Yim, A. P. Incidence of chest wall paresthesia after video-assisted thoracic surgery for primary spontaneous pneumothorax. Eur. J. Cardiothorac. Surg., 2004, roč. 25, č. 6, s. 1054–1058.