Uniportal thoracoscopy for pneumothorax

Introduction: Videothoracoscopy (VATS) is the gold standard for pneumothorax (PNX). However, in the last years, the surgical technique has been progressively modified towards less invasiveness to reduce postoperative pain and hospitalization. We present our experience with uniportal VATS to treat PNX. Methods: Seventy-six patients (mean age 19 ±14 years) with PNX underwent surgery with an uniportal approach. In fifty-eight patients (76.3%) the indication was a recurrence of previous spontaneous PNX, in 14 (18.4%) prolonged air leakage after chest tube placement for the first episode of PNX and in 4 (5.3%) redo surgery after no resolution of air leakage. One patient with bilateral PNX was simultaneously treated on both sides. All patients had a chest drainage before the surgery and VATS has been performed through a single port of 2.5 cm corresponding to the chest tube insertion. All patients have received blebs or bullae resection and partial parietal pleurectomy. Results: One postoperative bleeding required reoperation through the same approach. One recurrence on the operated side occurred after 2 years and it was successfully treated with uniportal VATS through the previous incision. Comparing this series with an historical population of patients treated with three-port VATS, we observed a significant decrease of postoperative pain measured with Visual Analog Scale (VAS) at 1st postoperative day, at discharge and at one month (2.92 vs 4.03 p=0.04; 1.2 vs 2.6 p=0.04; 0.58 vs 1.34 p=0.03). Furthermore, Uniportal group has been discharged earlier (3.67 vs 6.3 days; p=0.003). Conclusions: Uniportal VATS is a safe and effective approach to treat PNX also in difficult situations.