Pain versus Gain: Multiport versus single-port thoracoscopic surgery for pediatric pneumothorax a case series

Abstract

BackgroundThe indications for single-incision thoracoscopic surgery in children are expanding. We present outcome comparisons in single versus multi-port surgical technique for management of Primary Spontaneous Pneumothorax (PSP) in seven children. MethodsThis retrospective chart review of the outcomes from a single-surgeon's experience in thoracoscopic technique over a two-year period includes seven cases, divided into two groups: traditional multiport video assisted thoracoscopic surgery (MP-VATS) (n = 3) versus single-port VATS (SP-VATS) (n = 4). Data for patient demographics, chest tube placement, operation details, opioids usage, and postoperative course were recorded and analyzed. ResultsSeven patients had a median age of 14.88 years [range 12–17 years] with a male predominance 67% MP-VATS and 75% SP-VATS (p = 0.41). Average time to surgery: 3.6 days (p = 0.21) operating time: 1.2 hours (p = 0.09). Estimated blood loss was higher for MP-VATS 5.33 ml vs SP-VATS 2.25 ml but not statistically significant (p = 0.11). Opioids given in the post-operative period until chest tube removal were similar: MP 0.19 vs SP 0.12 mg/kg (p = 0.17). Time to chest tube removal was significantly longer at 5.54 vs 3.59 days for MP-VATS vs SP-VATS (p < 0.05). Length of stay was 10.46 vs 8.33 days for MP-VATS vs SP-VATS (p = 0.30). One SP patient had recurrent pneumothorax after chest tube removal, requiring replacement of chest tube, one MP patient required an additional surgery for contralateral PSP. ConclusionIn this small case series, outcomes were similar for MP-VATS and SP-VATS for PSP, but chest tube removal was earlier in SP. This provides a convincing basis to expand the usage for this technique.