Thoracoscopy for spontaneous pneumothorax.

Video-assisted thoracic surgical approaches appear to be viable alternatives to thoracotomy when surgical management of spontaneous pneumothorax is required. Apical bullae of the lung can be resected, and pleural abrasion can be accomplished with minimal postoperative morbidity and usually a shorter postoperative stay in hospital. Fifteen patients with primary (n = 9) and secondary (n = 6) spontaneous pneumothoraces have recently been treated by our group with the video-assisted thoracic surgical approach. Secondary pneumothoraces in the 6 patients were a result of cystic fibrosis (n = 2) and chronic obstructive pulmonary disease (n = 2), iatrogenic (n = 1), and post heart-lung transplantation (n = 1). All were treated by endoscopic stapled resection of bullous disease and pleural abrasion. There were no deaths. In 2 patients with secondary spontaneous pneumothorax, recurrent pneumothoraces developed eventually requiring thoracotomy for direct surgical management.