Initial Spontaneous Pneumothorax: Role of Thoracoscopic Therapy

Abstract

The management of spontaneous pneumothorax (SP) is complicated by the many clinical settings in which it occurs and the lack of accepted guidelines for management. Primary spontaneous pneumothorax (PSP) occurs in persons without obvious underlying lung disease with a reported incidence of 7.4 to 18/100,000 per year for men and 1.2 to 6/100,000 per year for women. Secondary spontaneous pneumothorax (SSP) complicates an underlying lung disease, most often chronic obstructive pulmonary disease (COPD), with a reported incidence similar to that of PSP. Because of the additional presence of the patient’s underlying lung disease, SSP is considered a potentially life-threatening event, while PSP is rarely life threatening. In this chapter, we will focus on the possible role of video-assisted thoracic surgery (VATS) as first-line therapy for patients presenting with their first episode of PSP, in contrast to the traditional approach of initial nonoperative management with surgical therapy reserved only for recurrent PSP. We will also briefly discuss the limited role of VATS as initial therapy for patients presenting with their first episode of SSP.