The role of awake video-assisted thoracoscopic surgery in spontaneous pneumothorax

Objective: We assessed in a randomized study the feasibility and efficacy of awake video-assisted thoracoscopic bullectomy with pleural abrasion to treat spontaneous pneumothorax. Methods: Between January 2001 and June 2005, a total of 43 patients with primary spontaneous pneumothorax were randomly assigned by computer to undergo video-assisted thoracoscopic bullectomy and pleural abrasion under sole thoracic epidural anesthesia or general anesthesia with single-lung ventilation ( control group). Primary outcome measures included technical feasibility and patient satisfaction with anesthesia as scored into 4 grades ( from 1, unsatisfactory, to 4, excellent). Secondary outcome measures included global operating room time, assessment of thoracic pain by visual analog pain scale, number of nursing care calls, hospital stay, and recurrences within 12 months. Results: In the awake group, technical feasibility was scored as excellent, good, and satisfactory in 8, 7, and 6 patients, respectively. Intergroup comparisons ( awake versus control) showed that global operating room time ( 78.0 +/- 20.0 vs 105.0 +/- 15.0 minutes, P < .0001), perioperative visual analog pain scale score ( 2.0 +/- 3.0 vs 3.5 +/- 2.0, P = .005), nursing care calls ( 2.0 +/- 1 vs 3.0 +/- 3.0, P = .017), hospital stay ( 2.0 +/- 1.0 days vs 3.0 +/- 1.0 days, P < .0001), and overall costs ( euro2540 +/- euro352 vs euro3550 +/- euro435, P < .0001) were significantly better in the awake group. In the awake group, 5 patients ( 23.8%) could be discharged within the first 24 postoperative hours. One patient in the awake group and 2 patients in the control group had recurrences within 12 months ( difference not significant). Conclusion: In our study, awake video-assisted thoracoscopic bullectomy with pleural abrasion proved easily feasible and resulted in shorter hospital stays and reduced procedure-related costs while providing equivalent outcome to procedures performed under general anesthesia.