Current Thoracic Surgery 2024 , Vol 9 , Issue 1
VATS versus open thoracotomy in patients with spontaneous pneumothorax: where do we stand?
Nexhati Jakupi1,Risto Colanceski1,Ljubica Atanasova1,Despot Despotovski1
1Department of Thoracic Surgery, University Clinic Mother Theresa, Skopje, Macedonia, the Former Yugoslav Republic of DOI : 10.26663/cts.2024.002 Viewed : 980 - Downloaded : 239 Background: Spontaneous pneumothorax (SP) can be surgically treated with video-assisted thoracoscopic surgery (VATS) or conventional open thoracotomy (OT), but there are still controversies in the literature concerning the outcome of both procedures. We aim to compare VATS and OT in the treatment of SP, in perioperative and postoperative outcome, as well as to determine which procedure is more cost-effective for both the patients and the health care system.

Materials and Methods: Overall, 136 patients underwent surgery for SP at our institution, out of which 104 met the inclusion criteria of our study. Patients were further divided into two groups, consisting of 56 and 48 patients who underwent VATS and OT, respectively. Data were collected prospectively for 5 years and comparison of the perioperative and postoperative outcome, as well as cost-effectiveness of both procedures was performed.

Results: The VATS group was superior to the OT with shorter duration of surgery (87.77 vs 132.92 min.; p < 0.05), reduced length of hospital stay (7.28 vs 9.81 days; p < 0.05) and chest drain duration (4.84 vs 5.98 days; p < 0.05). There was no statistically significant difference in the recurrence rate, bleeding and postoperative complications. Average cost per patient for VATS was significantly lower than the cost for open thoracotomy (EUR 1504.93 vs EUR 1973.09; p < 0.05).

Conclusions: VATS can be implemented as the optimal approach in the treatment of SP given the current clinical, financial and cosmetic advantages. Like other minimally-invasive procedures, VATS has an associated learning curve which, once is surpassed, any complications are less likely to be prevalent and optimum results can be achieved. Keywords : pneumothorax, thoracotomy, surgery, video-assisted