Thoracoscopic transareolar approach for primary spontaneous pneumothorax in young male patients

Abstract

: Most patients with primary spontaneous pneumothorax (PSP) are treated via thoracoscopic surgery. However, the number of ports used during thoracoscopic surgery (i.e., uni- or multi-portal) varies among institutions. We evaluated the efficacy of the thoracoscopic transareolar approach for the treatment of PSP. To the best of our knowledge, four studies (two of them were our reports) have evaluated the usefulness of the thoracoscopic transareolar approach for the treatment of PSP. Two of the studies, including ours, had a comparative arm while the other two reports, including ours, had a single arm. We used three ports for the transareolar approach for PSP treatment; by contrast, the other previous studies used one or two ports. However, any studies, including ours, have demonstrated higher cosmetic satisfaction with the transareolar than conventional approach, in which the skin incisions were made on the axillary line. Furthermore, the areolar incision made during the transareolar approach was not visible at the sixth postoperative month. Compared to patients undergoing thoracic surgery for other diseases, those undergoing surgery for PSP are younger and place greater emphasis on the cosmetic outcome. Therefore, higher cosmetic satisfaction with the transareolar approach is a major advantage over the conventional approach. Two previous studies reported equivalent perioperative outcomes between the transareolar and conventional approaches. Both of the single-arm studies also reported acceptable perioperative outcomes. Although a comparative study revealed that postoperative pain was similar between the transareolar and conventional approaches, in the other study postoperative pain was lower with the transareolar than conventional approach. Based on the aforementioned findings of better cosmetic satisfaction and postoperative pain relief, as well as equivalent perioperative outcomes, the transareolar approach may be superior to the standard treatment for young males with PSP.