Surgical Endoscopy

, Volume 26, Issue 3, pp 607–614 | Cite as

A modified two-port thoracoscopic technique versus axillary minithoracotomy for the treatment of recurrent spontaneous pneumothorax: a prospective randomized study

  • Christophoros N. ForoulisEmail author
  • Kyriakos Anastasiadis
  • Nicholas Charokopos
  • Polychronis Antonitisis
  • Homerus V. Halvatzoulis
  • George T. Karapanagiotidis
  • Vassilis Grosomanidis
  • Christos Papakonstantinou



Currently, most thoracic surgeons perform surgical pleurodesis for recurrent spontaneous pneumothorax (RSP) by video-assisted thoracic surgery (VATS). However, the superiority of VATS over axillary minithoracotomy is not been established in prospective studies to date. A modified two-port VATS technique and axillary minithoracotomy were prospectively evaluated for possible differences in the short- and long-term outcome for patients.


In this study, 66 consecutive patients underwent surgical pleurodesis for RSP through either a modified two-port VATS procedure (group A, 33 patients) or axillary minithoracotomy (group B, 33 patients). According to the study design (NCT01192217), the patients were randomly assigned to the two groups, which were similar in terms of age and body mass index. One-lung ventilation time, histology of the available lung parenchyma specimens, early postoperative complications, length of chest tube drainage and hospital stay, recurrence rate, and a score for patient satisfaction with treatment based on the sum of postoperative pain, dependent-arm mobilization, and return to full activity subscores were evaluated. The follow-up period varied from 3 to 53 months (median, 30 months).


The one-lung ventilation and operating times were significantly longer (p < 0.001) in group A than in group B. The overall detection of blebs, bulla, or both was 51.5% in group A and 63.8% in group B. The recurrence rate, complication rate, postoperative chest tube drainage duration, postoperative hospital stay, and incidence of chronic pain did not differ between the two groups. The score for patient satisfaction with treatment was significantly higher in group A than in group B (p < 0.001) according the subscores for better dependent-arm mobilization and return to full activity.


Axillary minithoracotomy and VATS are equally effective for the treatment of RSP, although the rate for resection of blebs, bulla, or both is higher with the axillary minithoracotomy procedure. Although VATS is more time consuming, it offers to the patient more satisfaction with treatment.


Axillary minithoracotomy Recurrent spontaneous pneumothorax Spontaneous pneumothorax Surgical pleurodesis Thoracoscopy VATS 



Christophros N. Foroulis, Kyriakos Anastasiadis, Nicholas Charokopos, Polychronis Antonitsis, Homerus V. Halvatzoulis, George T. Karapanagiotidis, Vassilis Grossomanidis, and Christos Papakonstantinou have no conflicts of interest or financial ties to disclose.


  1. 1.
    Mack MJ, Scruggs GR, Kelly KM, Shennib H, Landreneau RJ (1997) Video-assisted thoracic surgery: has technology found its place? Ann Thorac Surg 64:211–215PubMedCrossRefGoogle Scholar
  2. 2.
    Baumann MH, Strange C, Heffner JE, Light R, Kirby TJ, Klein J, Luketich JD, Panacek EA, Sahn SA, for the ACCP pneumothorax consensus group (2001) Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest 119:590–602Google Scholar
  3. 3.
    Barker A, Maratos E, Edmonds L, Lim E (2007) Recurrence rates of video-assisted thoracoscopic versus open surgery in the prevention of recurrent pneumothoraces: a systematic review of randomized and nonrandomized trials. Lancet 370:329–335PubMedCrossRefGoogle Scholar
  4. 4.
    Tschopp J-M, Rami-Porta R, Noppen M, Astoul P (2006) Management of spontaneous pneumothorax: state of the art. Eur Resp J 28:637–650CrossRefGoogle Scholar
  5. 5.
    Henry M, Arnold T, Harvey J, on behalf of the BTS pleural disease group, a subgroup of the BTS standards of care committee (2003) BTS guidelines for the management of spontaneous pneumothorax. Thorax 58 (Suppl II):ii39–ii52Google Scholar
  6. 6.
    Hunt I, Barber B, Southon R, Treasure T (2007) Is talc pleurodesis safe for young patients following primary spontaneous pneumothorax? Interact Cardiovasc Thorac Surg 6:117–120PubMedCrossRefGoogle Scholar
  7. 7.
    Kim KH, Kim HK, Han JY, Kim JT, Won YS, Choi SS (1996) Transaxillary minithoracotomy versus video-assisted thoracic surgery for spontaneous pneumothorax. Ann Thorac Surg 61:1510–1512PubMedCrossRefGoogle Scholar
  8. 8.
    Horio H, Nomori H, Fuyuno G, Kobayashi R, Suemasu K (1998) Limited axillary thoracotomy vs. video-assisted thoracoscopic surgery for spontaneous pneumothorax. Surg Endosc 12:1155–1158PubMedCrossRefGoogle Scholar
  9. 9.
    Rocco G, Martin-Ucar A, Passera E (2004) Uniportal VATS wedge pulmonary resections. Ann Thorac Surg 77:726–728PubMedCrossRefGoogle Scholar
  10. 10.
    Luh S-P, Chou M-C, Wang L-S, Chen JY, Tsai TP (2005) Video-assisted thoracoscopic surgery in the treatment of complicated parapneumonic effusions or empyemas. Chest 127:1427–1432PubMedCrossRefGoogle Scholar
  11. 11.
    Brunelli A, Xiume F, Refai M, Sabbatini A (2006) Bilateral staged uniportal VATS for synchronous lung cancers. Interact Cardiovasc Thorac Surg 5:658–659PubMedCrossRefGoogle Scholar
  12. 12.
    Salati M, Brunelli A, Xiumè F, Refai M, Sciarra V, Soccetti A, Sabbatini A (2008) Uniportal video-assisted thoracic surgery for primary spontaneous pneumothorax: clinical and economic analysis in comparison to the traditional approach. Interact Cardiovasc Thoras Surg 7:63–66CrossRefGoogle Scholar
  13. 13.
    Rodríguez-Panadero F (2008) Medical thoracoscopy. Respiration 76:363–372PubMedCrossRefGoogle Scholar
  14. 14.
    Massard G, Thomas P, Wihlm J-M (1998) Minimally invasive management for first and recurrent pneumothorax. Ann Thorac Surg 66:592–599PubMedCrossRefGoogle Scholar
  15. 15.
    Qureshi R, Nugent A, Hayat J, Qureshi M, Norton R (2008) Should surgical pleurectomy for spontaneous pneumothorax be always thoracoscopic? Interact Cardiovasc Thorac Surg 7:569–572PubMedCrossRefGoogle Scholar
  16. 16.
    Noppen M, Dekeukeleire T, Hanon S, Stratakos G, Amjadi K, Madsen P, Meysman M, D’Haese J, Vincken W (2006) Fluorescein-enhanced autofluorescence thoracoscopy in patients with primary spontaneous pneumothorax and normal subjects. Am J Respir Crit Care Med 174:26–30PubMedCrossRefGoogle Scholar
  17. 17.
    Noppen M, DeKeukeleire T (2008) Pneumothorax. Respiration 76:121–127PubMedCrossRefGoogle Scholar
  18. 18.
    Chen J-S, Hsu H-H, Kuo S-W, Tsai P-R, Chen RJ, Lee J-M, Lee Y-C (2004) Effects of additional minocycline pleurodesis after thoracoscopic procedures for primary spontaneous pneumothorax. Chest 125:50–55PubMedCrossRefGoogle Scholar
  19. 19.
    Györik S, Erni S, Studler U, Hodek-Wuerz R, Tamm M, Chhajed PN (2007) Long-term follow-up of thoracoscopic talc pleurodesis for primary spontaneous pneumothorax. Eur Resp J 29:757–760CrossRefGoogle Scholar
  20. 20.
    Ayed AK, Al-Din HJ (2009) Video-assisted thoracoscopy versus thoracotomy for primary spontaneous pneumothorax: a randomized controlled trial. Med Principles Pract 9:113–118CrossRefGoogle Scholar
  21. 21.
    Balduyck B, Hendriks J, Lauwers P, Van Schil P (2008) Quality-of-life evolution after surgery for primary or secondary spontaneous pneumothorax: a prospective study comparing different surgical techniques. Interact Cardiovasc Thorac Surg 7:45–49PubMedCrossRefGoogle Scholar
  22. 22.
    Chen F, Yamada T, Aoyama A, Isowa N, Chihara K (2006) Position of chest tube at video-assisted thoracoscopic surgery for spontaneous pneumothorax. Respiration 73:329–333PubMedCrossRefGoogle Scholar
  23. 23.
    Passlick B, Born Ch, Sienel W, Thetter O (2001) Incidence of chonic pain after minimal-invasive surgery for spontaneous pneumothorax. Eur J Cardiothorac Surg 19:355–359PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Christophoros N. Foroulis
    • 1
    Email author
  • Kyriakos Anastasiadis
    • 1
  • Nicholas Charokopos
    • 1
  • Polychronis Antonitisis
    • 1
  • Homerus V. Halvatzoulis
    • 1
  • George T. Karapanagiotidis
    • 1
  • Vassilis Grosomanidis
    • 2
  • Christos Papakonstantinou
    • 1
  1. 1.Department of Thoracic and Cardiovascular Surgery, Aristotle University Medical SchoolAHEPA University HospitalThessalonikiGreece
  2. 2.Department of Anaesthesiology and Intensive Care, Aristotle University Medical SchoolAHEPA University HospitalThessalonikiGreece

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