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, 張泳, 任小朋, 等. 加速康復理念在單孔胸腔鏡肺癌根治術的應用. 中華腔鏡外科雜志(電子版), 2017, 10(6): 376-380.
8.	王向東, 蔡開燦, 葉靖, 等. 喉罩全麻胸腔鏡下治療多汗癥和肺大皰2例. 實用醫學雜志, 2012, 28(15): 26-41.
9.	郭志華, 殷偉強, 張鑫, 等. 非氣管內插管麻醉下右下肺楔形切除術后不留置胸管一例. 中華胸部外科電子雜志, 2014, 1(1): 63-65.
10.	代小探, 宋平平, 張百江. 非氣管插管在胸外科VATS中的應用. 中國肺癌雜志, 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.	劉永志, 陳劍, 劉建, 等. Tubeless VATS技術治療自發性氣胸的臨床應用. 吉林醫學, 2018, 39(11): 2061-2064.
14.	蔡開燦, 王向東, 葉靖, 等. 喉罩全麻與氣管插管全麻胸腔鏡手術治療肺大皰的臨床對照研究. 南方醫科大學學報, 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, 張泳, 任小朋, 等. 加速康復理念在單孔胸腔鏡肺癌根治術的應用. 中華腔鏡外科雜志(電子版), 2017, 10(6): 376-380.
8. 王向東, 蔡開燦, 葉靖, 等. 喉罩全麻胸腔鏡下治療多汗癥和肺大皰2例. 實用醫學雜志, 2012, 28(15): 26-41.
9. 郭志華, 殷偉強, 張鑫, 等. 非氣管內插管麻醉下右下肺楔形切除術后不留置胸管一例. 中華胸部外科電子雜志, 2014, 1(1): 63-65.
10. 代小探, 宋平平, 張百江. 非氣管插管在胸外科VATS中的應用. 中國肺癌雜志, 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. 劉永志, 陳劍, 劉建, 等. Tubeless VATS技術治療自發性氣胸的臨床應用. 吉林醫學, 2018, 39(11): 2061-2064.
14. 蔡開燦, 王向東, 葉靖, 等. 喉罩全麻與氣管插管全麻胸腔鏡手術治療肺大皰的臨床對照研究. 南方醫科大學學報, 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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