A Comparative Study Of Video-assisted Thoracoscopic Surgery With Endoscopic Linear Stapling Device Or Ligation And Suture For The Treatment Of Spontaneous Pneumothorax

ObjectiveVideo-assisted thoracoscopic surgery (VATS) is a type of thoracic surgery performed using a small video camera that is introduced into the patient’s chest via a scope. The surgeon is able to view the instruments that are being used along with the anatomy on which the surgeon is operating. The camera and instruments are inserted through separate holes in the chest wall also known as "ports". These small ports are advantageous because the chance for infection and wound dehiscence are drastically reduced. This allows for a faster recovery by the patient and a greater chance for the wound to heal. Spontaneous pneumothorax (SP) is an abnormal collection of air or gas in the pleural space separating the lung from the chest wall which may interfere with normal breathing. Nowadays, SP can be performed with VATS and compared to open thoracotomy, VATS offers a shorter in-hospital stays, less need for postoperative pain control, and a reduced risk of lung problems after surgery. The purpose of the study is to compare the clinical results of endoscopic linear stapler(Endo-GIA) and laparoscopic suture in treatment of SP through analyzing the clinical cases.MethodsIn the investigation, we retrospective analysis and summary the clinical manifestation, diagnostic imaging, surgical therapeutic data of92patients with primary spontaneous pneumothorax (PSP) in hospital during the in March2009and March2012. These patients were randomly divided into two groups:Endo-GIA group and suture group.There are48patients in Endo-GIA group,47males and1females,24±5years old. Among them,19cases have smoking history (39.6%),32cases have a lanky type body (66.7%),34cases of initial episodes of pneumothorax (70.8%),13cases of second episodes of pneumothorax (27.1%) and1case of third episodes of pneumothorax (2.1%). There are44patients in suture group,43males and1females,25±8years old. Among them,21cases have smoking history (47.7%),28cases have a lanky type body (63.6%),37cases of initial episodes of pneumothorax (84.1%),6cases of second episodes of pneumothorax (13.6%) and1case of third episodes of pneumothorax (2.3%). Besides, none of the patients suffered form SP have had surgery before.ResultsAll the patients had no operative mortality, intraoperative transit the thoracotomy and other serious postoperative complications. Postoperative recurrence were observed in5patients, including3cases in Endo-GIA group and2cases in sature group.The recurrence time was between10-18months after surgery. All the relapsed patients were cured with thoracentesis pumping treatment. There was no significant differences in hospitalization time, postoperative complications, chest tube placement time and poor healing of observation hole after surgery between the two groups. However, Endo-GIA group had less blood loss and shorter operative time compared to suture group, but with a higher cost of surgery.ConclusionBoth of the two surgical approach are effective and safe, Endoscopic instruments applicable to the wide base of clusters of bullae or multiple bullae patients. Suture method is suitable for single bullae patients.