The clinical application of tubeless video-assisted thoracoscopic surgery in the treatment of spontaneous pneumothorax_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Renpeng ¹ , HAN Wenjian ² , LI Yan ¹ , HU Wenteng ¹ ,  HAN Biao ¹

1. Department of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, P.R. China;
2. The Third Department of Surgery, National Hospital of Enshi Autonomous Prefecture, Enshi, 445000, Hubei, P.R. China;

Corresponding author：

HAN Biao, Email: hanbiao66@163.com

Keywords：

Tubeless video-assisted thoracoscopic surgery; spontaneous pneumothorax; thoracoscopic surgery

DOI：

10.7507/1007-4848.201903039

Video：

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Objective To explore the safety, feasibility and superiority of tubeless video-assisted thoracoscopic surgery (VATS) in the treatment of spontaneous pneumothorax.Methods We retrospectively analyzed the clinical data of 38 patients with primary spontaneous pneumothorax treated in our hospital from February 2017 to July 2018. Tubeless bullectomy was performed in 18 patients, including 11 males and 7 females, aged 14.3±1.5 years. Twenty patients underwent conventional thoracoscopic bullae resection, including 12 males and 8 females, aged 14.5±1.7 years. The clinical effectiveness was compared.Results All the 38 patients completed the operation successfully under the single-port thoracoscopy, without the transfer of intubation and secondary surgery. Operation time (67.3±13.3 min vs. 81.4±13.4 min, P=0.002), preoperative anesthesia time (14.2±2.6 min vs. 18.5±2.6 min, P=0.000), postoperative anesthesia recovery time (17.1±2.6 min vs. 26.5±5.0 min, P=0.000), visual simulation score of postoperative pain (2.3±0.9 vs. 5.2±1.0, P=0.000), postoperative activity time (1.3±0.4 d vs. 2.9±0.6 d, P=0.000), postoperative hospitalization time (2.9±0.8 d vs. 5.6±1.3 d, P=0.000), hospitalization cost (35.0±6.0 kyuan vs. 59.0±10.0 kyuan, P=0.000) were better in the control group. There was no significant difference in intraoperative blood loss (73.2±4.6 mL vs. 73.9±4.1 mL) and postoperative lung revascularization time (29.3±2.4 h vs. 29.7±2.5 h) between the two groups (P>0.05).Conclusion Compared with traditional thoracoscopic bullectomy, tubeless VATS technique is safe and reliable in the treatment of spontaneous pneumothorax, with mild pain and quick recovery, in line with the concept of fast track surgery and worthy of clinical promotion.

Citation： LI Renpeng, HAN Wenjian, LI Yan, HU Wenteng, HAN Biao. The clinical application of tubeless video-assisted thoracoscopic surgery in the treatment of spontaneous pneumothorax. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(1): 57-60. doi: 10.7507/1007-4848.201903039 Copy

1.	Torresini G, Vamlarili M, Divisi D, et al. Is video assisted thoracic surgery justified at first spontaneous pneumothorax. Eur J Cardiothorac Surg, 2001, 20(1): 42-45.
2.	Chan P, Clarke P, Daniel FJ, et al. Efficacy study of video assisted thoracoscopic surgery pleurodesis for spontaneous pneumothorax. Ann Thorac Surg, 2001, 71(2): 452-454.
3.	Wang BY, Liu CY, Hsu PK, et al. Single-incision versus multiple- incision thoracoscopic lobectomy and segmentectomy: a propensity- matched analysis. Ann Surg, 2015, 26(1): 793-799.
4.	Han KN, Kim HK, Choi YH. Comparison of single port versus multiport thoracoscopic segmentectomy. J Thorac Dis, 2016, 8(3): S279-S286.
5.	Chen KC, Cheng YJ, Hung MH, et al. Nonintubated thoracoscopic lung resection: a 3-year experience with 285 cases in a single institution. J Thorac Dis, 2012, 4(4): 347-351.
6.	Chen JS, Cheng YJ, Lung MH. Nonintubated thoracoscopic lobectomy for lung cancer. Ann Surg, 2011, 254(6): 10-38.
7.	任占良, 张泳, 任小朋, 等. 加速康复理念在单孔胸腔镜肺癌根治术的应用. 中华腔镜外科杂志(电子版), 2017, 10(6): 376-380.
8.	王向东, 蔡开灿, 叶靖, 等. 喉罩全麻胸腔镜下治疗多汗症和肺大疱2例. 实用医学杂志, 2012, 28(15): 26-41.
9.	郭志华, 殷伟强, 张鑫, 等. 非气管内插管麻醉下右下肺楔形切除术后不留置胸管一例. 中华胸部外科电子杂志, 2014, 1(1): 63-65.
10.	代小探, 宋平平, 张百江. 非气管插管在胸外科VATS中的应用. 中国肺癌杂志, 2016, 19(5): 312-316.
11.	Liu CY, Hsu PK, Chien HC, et al. Tubeless single-port thoracoscopic sublobar resection: indication and safety. J Thorac Dis, 2018, 10(6): 3729-3737.
12.	Gonzalez-Rivas D, Yang Y, Guido W, et al. Non-intubated uniportal video-assisted thoracoscopic lobectomy. Ann Cardiothorac Surg, 2016, 5(2): 151-153.
13.	刘永志, 陈剑, 刘建, 等. Tubeless VATS技术治疗自发性气胸的临床应用. 吉林医学, 2018, 39(11): 2061-2064.
14.	蔡开灿, 王向东, 叶靖, 等. 喉罩全麻与气管插管全麻胸腔镜手术治疗肺大疱的临床对照研究. 南方医科大学学报, 2013, 33(5): 756-760.
15.	Feneley RC, Hopley IB, Wells PN. Urinary catheters: history, current status, adverse events and research agenda. J Med Eng Technol, 2015, 39(8): 459-470.
16.	Holbek BL, Hansen HJ, Kehlet H, et al. Thoracoscopic pulmonary wedge resection without post-operative chest drain: an observa- tional study. Gen Thorac Cardiovasc Surg, 2016, 64(10): 612-617.
17.	Li S, Jiang L, Ang KL, et al. New tubeless video-assisted thoracos- copic surgery for small pulmonary nodules. Eur J Cardiothorac Surg, 2017, 51(4): 689-693.
18.	Zhao ZR, Lau RW, Ng CS. Anaesthesiology for uniportal VATS: double lumen, single lumen and tubeless. J Vis Surg, 2017, 3: 108.
19.	Cui F, Liu J, Li S, et al. Tubeless video-assisted thoracoscopic surgery (VATS) under non-intubated, intravenous anesthesia with spontaneous ventilation and no placement of chest tube postoperatively. J Thorac Dis, 2016, 8(8): 22-26.

1. Torresini G, Vamlarili M, Divisi D, et al. Is video assisted thoracic surgery justified at first spontaneous pneumothorax. Eur J Cardiothorac Surg, 2001, 20(1): 42-45.
2. Chan P, Clarke P, Daniel FJ, et al. Efficacy study of video assisted thoracoscopic surgery pleurodesis for spontaneous pneumothorax. Ann Thorac Surg, 2001, 71(2): 452-454.
3. Wang BY, Liu CY, Hsu PK, et al. Single-incision versus multiple- incision thoracoscopic lobectomy and segmentectomy: a propensity- matched analysis. Ann Surg, 2015, 26(1): 793-799.
4. Han KN, Kim HK, Choi YH. Comparison of single port versus multiport thoracoscopic segmentectomy. J Thorac Dis, 2016, 8(3): S279-S286.
5. Chen KC, Cheng YJ, Hung MH, et al. Nonintubated thoracoscopic lung resection: a 3-year experience with 285 cases in a single institution. J Thorac Dis, 2012, 4(4): 347-351.
6. Chen JS, Cheng YJ, Lung MH. Nonintubated thoracoscopic lobectomy for lung cancer. Ann Surg, 2011, 254(6): 10-38.
7. 任占良, 张泳, 任小朋, 等. 加速康复理念在单孔胸腔镜肺癌根治术的应用. 中华腔镜外科杂志(电子版), 2017, 10(6): 376-380.
8. 王向东, 蔡开灿, 叶靖, 等. 喉罩全麻胸腔镜下治疗多汗症和肺大疱2例. 实用医学杂志, 2012, 28(15): 26-41.
9. 郭志华, 殷伟强, 张鑫, 等. 非气管内插管麻醉下右下肺楔形切除术后不留置胸管一例. 中华胸部外科电子杂志, 2014, 1(1): 63-65.
10. 代小探, 宋平平, 张百江. 非气管插管在胸外科VATS中的应用. 中国肺癌杂志, 2016, 19(5): 312-316.
11. Liu CY, Hsu PK, Chien HC, et al. Tubeless single-port thoracoscopic sublobar resection: indication and safety. J Thorac Dis, 2018, 10(6): 3729-3737.
12. Gonzalez-Rivas D, Yang Y, Guido W, et al. Non-intubated uniportal video-assisted thoracoscopic lobectomy. Ann Cardiothorac Surg, 2016, 5(2): 151-153.
13. 刘永志, 陈剑, 刘建, 等. Tubeless VATS技术治疗自发性气胸的临床应用. 吉林医学, 2018, 39(11): 2061-2064.
14. 蔡开灿, 王向东, 叶靖, 等. 喉罩全麻与气管插管全麻胸腔镜手术治疗肺大疱的临床对照研究. 南方医科大学学报, 2013, 33(5): 756-760.
15. Feneley RC, Hopley IB, Wells PN. Urinary catheters: history, current status, adverse events and research agenda. J Med Eng Technol, 2015, 39(8): 459-470.
16. Holbek BL, Hansen HJ, Kehlet H, et al. Thoracoscopic pulmonary wedge resection without post-operative chest drain: an observa- tional study. Gen Thorac Cardiovasc Surg, 2016, 64(10): 612-617.
17. Li S, Jiang L, Ang KL, et al. New tubeless video-assisted thoracos- copic surgery for small pulmonary nodules. Eur J Cardiothorac Surg, 2017, 51(4): 689-693.
18. Zhao ZR, Lau RW, Ng CS. Anaesthesiology for uniportal VATS: double lumen, single lumen and tubeless. J Vis Surg, 2017, 3: 108.
19. Cui F, Liu J, Li S, et al. Tubeless video-assisted thoracoscopic surgery (VATS) under non-intubated, intravenous anesthesia with spontaneous ventilation and no placement of chest tube postoperatively. J Thorac Dis, 2016, 8(8): 22-26.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The clinical application of tubeless video-assisted thoracoscopic surgery in the treatment of spontaneous pneumothorax

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