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Objective: To analyze the outcome of Video assisted Thoracoscopy (Vats) in Primary Spontaneous Pneumothorax
(PSP).
Methods: This case series was carried out from Jan 2010 to Jan 2017 in Department of Thoracic Surgery CMH
Rawalpindi and Lahore. A total of 98 patients underwent Video-assisted thoracoscopic for PSP. Inclusion criteria
were physiologically fit patients with PSP for recurrent attacks, occupational hazards and prolonged air leak.
Exclusion criteria included secondary spontaneous pneumothorax, previous pleurodesis and physiologically unfit
patient for general anaesthesia. Vanderschueren's thoracoscopic classification was used for macroscopic staging. A
3-port technique was used for apical stapling with partial pleurectomy up to 6th rib. Parietal pleura and diaphragm
was also abraded.
Results: Occupational hazard was the commonest indication for surgery, n= 39 (39.7%). This was followed by
recurrent pneumothorax 37 (37.7%), persistent air leak 19 (19.38%) and contra lateral pneumothorax n=4 (4.08%).
Mean age was 22.8 ± 6.5 years. Majority of the cases , 69(70.4%) were in stage 3 of Vanderschueren's classification.
Stage 4 were (18.5%) and stage 2 were 7 (7.14%). Mean operative time was 51 ± 14. 4 minutes. Postoperative
prolonged air leak occurred in 3 patients and post-operative neuralgia occurred in 8 patients. Mean follow-up was
22 ±5.5 months, range 5-24 months for all patients. One had generalized recurrence and 2 patients had
subpulmonic trapping of air.
Conclusions: Video-assisted thoracoscopic stapling and pleurectomy is an effective definitive treatment for primary
spontaneous pneumothorax when indicated with minimal recurrence.
Farhan Ahmed Majeed, Adeel Wyne, Yasser Saeed Khan, Ahmed Raza, Tashfeen Imtiaz, Usama Zafar. (2021) Video assisted thoracoscopic management of primary spontaneous pneumothorax, Journal of the Pakistan Medical Association, Volume 71, Issue 1.
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