Objectives:
The pneumothorax recurrence risk following VATS pleurectomy is reported as 4.8%.1 A single sub centimetre uniportal approach without bullectomy has never been described.
Method:
We conducted a two surgeon retrospective review of 76 patients treated surgically for PSP between December 2011 and October 2016. One surgeon's preference is a sub centimetre uniportal VATS pleurectomy without bullectomy with additional alcoholic Betadine pleurodesis. Failure was defined as recurrence of pneumothorax after removal of chest drain requiring re-operation. The impact of NSAIDs, number of ports, bullectomy and chemical pleurodesis were analysed. Statistical analysis was via the Fisher's exact test.
Results:
Of 76 patient admissions, 38 were urgent. 53 were male, 23 female, mean age 27 years (range 16-57). The overall failure rate was 5.1% (n=4, one patient failing pleurodesis for staged bilateral procedures). NSAID use (n=8) increased the failure rate from 3% to 22% (p=0.07). Three failures in 2 patients were in the single port/no bullectomy/Betadine pleurodesis cohort (n=22, 13.6%, p=0.07), in two cases patients were discharged with a chest drain in-situ. Of the 44 patients who underwent bullectomy, 2 returned histological diagnoses warranting follow-up (5% diagnostic yield).
Conclusion
Thoracoscopic pleurectomy with/without Alcoholic Betadine, should be considered as a technique that may minimise post operative pain and enhance early recovery. NSAID use should be avoided. Early discharge is facilitated if the chest drain remains in-situ.
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