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Eur J Cardiothorac Surg 1999;16:48-53
© 1999 Elsevier Science NL

Video-assisted thoracoscopic surgery does not deteriorate postoperative pulmonary gas exchange in spontaneous pneumothorax patients

^a Department of Surgery, Institute of Pulmonary Cancer Research, Chiba University School of Medicine, Chiba, Japan,
^b Department of Surgery, Sakura National Hospital, Chiba, Japan
^c Department of Anesthesiology, Sakura National Hospital, Chiba, Japan
^d Department of Clinical Research Institute, Sakura National Hospital, Chiba, Japan

Corresponding author. Tel.: +81-43-2227171 ext. 5464; fax: +81-43-2262172
e-mail: eysekine{at}aol.com

Objectives: Video-assisted thoracoscopic surgery (VATS) is generally recognized as a less invasive method than thoracotomy. However, the influence of VATS on postoperative pulmonary gas exchange has yet to be evaluated. Methods: Thirty eight patients with spontaneous pneumothorax were randomized into bullectomy by VATS (n=20) or axillary thoracotomy (n=18). Gas exchange was assessed by using hot wire mass spectrometer, and blood gas analysis preoperatively and postoperatively at 1, 3, 6, 12, 24, and 48 h and on days 4 and 6. Post operative pain control was managed by continuous epidural morphine injection and administration of diclofenac sodium orally or suppository. Postoperative atelectasis was assessed by daily chest roentgenograms. Results: VATS patients had continuously higher PaO₂ than axillary thoracotomy at 12, 48 h and day 4 postoperatively (P<0.05). Alveolar-arterial oxygen tension gradient in VATS patients was significantly less than that in patients with axillary thoracotomy from the 6th h throughout to the 4th day postoperatively (P<0.01). Use of postoperative analgesics and the incidence of peripheral atelectasis were more frequent in patients with axillary thoracotomy. Conclusions: Bullectomy via VATS was less deleterious to pulmonary gas exchange. Axillary thoracotomy caused worsening of gas exchange postoperatively due to incisional pain, chest wall deformity, and peripheral atelectasis.

Key Words: Pulmonary gas exchange • Thoracotomy • Video-assisted thoracoscopic surgery • Atelectasis • Spontaneous pneumothorax

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