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@#Objective To investigate the safety and efficiency of robotic lung segmentectomy. Methods The clinical data of 110 patients receiving robotic or thoracoscopic segmentectomy in our hospital between June 2015 and June 2019 were retrospectively analyzed. The patients were divided into a robotic group [n=50, 13 males and 37 females aged 53.0 (46.0, 60.0) years] and a thoracoscopic group [n=60, 21 males and 39 females aged 61.0 (53.0, 67.0) years]. A propensity score-matched analysis was adopted to compare the perioperative data between the two groups. Results After the propensity score-matched analysis, 34 patients were included in each group. In comparison with the thoracoscopic group, patients in the robotic group had less blood loss [40.0 (20.0, 50.0) mL vs. 60.0 (40.0, 80.0) mL, P<0.001], more stations of lymph node dissection [7.0 (6.0, 8.0) vs. 4.0 (3.0, 6.0), P<0.001], larger number of lymph node dissection [15.0 (11.0, 21.0) vs. 10.0 (6.0, 14.0), P=0.002], and a higher total cost of hospitalization [97.0 (92.0, 103.0) thousand yuan vs. 54.0 (42.0, 59.0) thousand yuan, P<0.001]. Conclusion In contrast with the thoracoscopic segmentectomy, robotic segmentectomy has a similar operative safety, but less blood loss and a thorough lymphadenectomy.
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To compare two methods of injecting ropivacaine as an intercostal nerve blocker, and for postoperative pain control after video-assisted thoracic surgery (VATS) in lung cancer patients. Methods: From August 2018 to November 2018, 60 patients who had undergone VATS with a diagnosis of lung cancer, were randomly assigned into two groups: control and test. After the surgery, the control group was injected with an intercostal nerve blocker (0.25% ropivacaine) via the inner thorax by the traditional method, and the test group was injected with ropivacaine via the outer thorax by an improved method. The pain scale was evaluated using the Visual Analogue Scale (VAS) and Prince Henry Pain Scale (PHPS) at 12 h (T1), 24 h (T2), 48 h (T3), and 72 h (T4) after the surgery. The dosage of administered morphine and the adverse effects of ropivacaine after surgery were also evaluated. Results: Injecting ropivacaine to the intercostal nerve by means of both, outer and inner thoracic injection showed satisfied analgesia, as evaluated by VAS and PHPS scores, and there were no significant differences between the two methods at any time point of analysis (T1-T4, P>0.05). The dosage of administered morphine and the time with chest tube were similar (P>0.05) between the groups. However, there were a few cases of subpleural hemorrhage in the test group. Conclusions: Intercostal nerve block with ropivacaine by means of both, outer and inner thoracic injection, showed satisfied analgesia, although, outer thoracic injection is more flexible with fewer complications.
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Resumen El secuestro pulmonar es una enfermedad congénita infrecuente caracterizada por la presencia de una porción de parénquima pulmonar que recibe vascularización independiente de la circulación sistémica. Se presentan tres casos de secuestro pulmonar intralobares, de presentación tardía, uno de ellos asociado a una malformación adenomatosa quística y en los cuales el manejo se completó por videotoracoscopia: dos de ellos con lobectomía total y uno con lobectomía sublobar. Se trata de una enfermedad de presentación clínica variable y cuyo tratamiento es, en la mayoría de los casos, quirúrgico, requiriéndose usualmente resecciones lobares, las cuales pueden llevarse a cabo de manera eficaz y segura por videotoracoscopia.
Abstract Pulmonary sequestration is an infrequent congenital disease characterized by the presence of a portion of pulmonary parenchyma that receives vascularization independent of the systemic circulation. We present three cases of intralobar pulmonary sequestration of late presentation, one of them associated with a cystic adenomatous malformation and in which the management was completed by videothoracoscopy: two of them with total lobectomy and the other with sublobar lobectomy. It is a disease of variable clinical presentation and whose treatment is, in most cases, surgical, usually requiring lobar resections, which can be carried out effectively and safely by video-assisted thoracoscopy.
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@#Objective To investigate the optimal procedure and short-term efficacy of uniportal video-assisted thoracic surgery (U-VATS) lobectomy for lung cancer. Methods The clinical data of 61 patients who underwent lobectomy using U-VATS by the same surgeon between April 2016 and February 2017 were retrospectively analyzed. There were 50 patients (40 males and 10 females, aged 61.4±6.6 years) with conventional procedure. And there were 60 patients (45 males and 15 females, aged 59.2±9.7 years) utilizing multiportal thoracoscopic surgery (M-VATS) during this period. Results The baseline characteristics in both groups such as age, gender, body mass index, comorbidity and tumor size were comparable (P>0.05). There was no postoperative mortality or conversion to thoracotomy in the study. The parameters such as operative time, blood loss, harvested lymph nodes, duration of chest tube drainage, and length of postoperative hospital stay were similar in both groups (P>0.05). However, there was a statistical difference in pain score at 12 h after surgery in favor of the U-VATS approach (3.2vs.4.3, P=0.04). Moreover, subgroup analysis indicated that the operation time using single-direction U-VATS was noticeably shorter than that in both conventional U-VATS and M-VATS (76.4 minvs.125.8 minvs.105.6 min, P<0.05). However, further analysis was not performed because of small sample. Conclusion The short-term efficacy of U-VATS lobectomy for lung cancer is noninferior to M-VATS, meanwhile, single-direction U-VATS lobectomy is feasible followed by shortened operative time.
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@#Objective To share the experience of single-stage bilateral pulmonary resections by video-assisted thoracic surgery (VATS) for multiple nodules. Methods Clinical records of patients undergoing one-stage bilateral resections of multiple pulmonary nodules between January 2015 and December 2016 in our institution were retrospectively reviewed and analyzed. There were 9 males and 15 females, aged from 33 to 69 (55.0±8.0) years. Two patients underwent bilateral lobectomy. Lobar-sublobar (L/SL) resection and bilateral sublobar resection (SL-SL) were conducted in 9 patients and 13 patients respectively. Results All operations completed successfully. Operation time was 135–330 (231.4±59.1) min, duration of use of chest drains was 2–17 (5.4±3.1) days. Overall duration of hospitalization after surgery was 5–37 (8.6±6.3) days. There was no perioperative death. Postoperative course was uneventful in 17 (70.8%) patients. The postoperative complications included one patient of incision infection and one patient of pulmonary infection. Persistent air leak for >3 days duration and unilateral pleural drainage for more than 200 ml/d were observed in 3 patients and 2 patients respectively. Conclusion Single-stage bilateral surgery in selected patients with synchronous bilateral multiple nodules is feasible and associated with satisfactory outcomes.
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Objective The aim of this study was to explore the feasibility and efficacy of single port video-assisted thora coscopic surgery(S-VATS) lobectomy for lung cancer.Methods Clinical data of consecutive 140 cases of lung cancer patients underwent S-VATS lobectomy with systematic lymph nodes dissection by the same group of surgeons between January 2013 and January 2016 was retrospectively analyzed,wbich was compared with 60 cases of multi-port VATS(M-VATS,M group) lobectomy in this period.The patients of S-VATS were divided into four groups according to the sequence of surgery(group A,B,C and D,35 cases in each group).The operation time,blood loss,number of dissected lymph nodes and nodal stations,the rate of S-VATS conversion to M-VATS or thoracotomy,postoperative complications,postoperative chest drainage as well as hospital stay were compared respectively between the five groups.Results There were no significant difference between the groups in terms of age,gender,BMI,comorbidity and T staging(PP ＞ 0.05).No one was converted to thoracotomy,and all of the sur gical specimens were negative (R0).Besides,the operation time of group A[(200.3 ± 46.3) min] was noticeably longer than that in group B [(170.9 ± 27.7) min],group C [(154.6 ± 25.0) min],group D [(142.6 ± 32.8) min] and group M [(137.3 ± 27.7) min] (P ＜ 0.05).Besides,the operation time of group B was longer than group D and M (P ＜ 0.05) while the operation time of group C was longer than group M(P =0.026),and there was no significant difference between group D and M (P =0.996).In addition,the blood loss in group A [(304.3 ± 119.0) ml] was significantly more than that of group B [(282.9 ±89.1)ml],group C[(232.9 ±82.2)ml],group D[(202.8 ±72.7)m1] and group M[(200.0 ±70.7)ml] (P ＜ 0.05) whilst the blood loss of group B was markedly more than that of group D and M (P ＜ 0.05),and no significant difference was indicated between group C,D and M(P ＞ 0.05).Moreover,there were 6 cases of blood vessel injury and 7 cases conversion to multi-port VATS in group A,which was evidently more than the other groups(P ＜ 0.05).Furthermore,the pain score of group A was remarkably higher than the other groups (P ＜ 0.05).However,the number of dissected lymph nodes,postoperative complications and chest drainage and hospital stay were similar among all the groups (P ＞ 0.05).Conclusion S-VATS lobectomy for treatment of lung cancer is feasible and effective with learning curve of nearly 70 cases,but it does not demonstrate any advantage compared with M-VATS.
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Objective The aim of this study was to explore the feasibility and efficacy of single port video-assisted thora coscopic surgery(S-VATS) lobectomy for lung cancer.Methods Clinical data of consecutive 140 cases of lung cancer patients underwent S-VATS lobectomy with systematic lymph nodes dissection by the same group of surgeons between January 2013 and January 2016 was retrospectively analyzed,wbich was compared with 60 cases of multi-port VATS(M-VATS,M group) lobectomy in this period.The patients of S-VATS were divided into four groups according to the sequence of surgery(group A,B,C and D,35 cases in each group).The operation time,blood loss,number of dissected lymph nodes and nodal stations,the rate of S-VATS conversion to M-VATS or thoracotomy,postoperative complications,postoperative chest drainage as well as hospital stay were compared respectively between the five groups.Results There were no significant difference between the groups in terms of age,gender,BMI,comorbidity and T staging(PP ＞ 0.05).No one was converted to thoracotomy,and all of the sur gical specimens were negative (R0).Besides,the operation time of group A[(200.3 ± 46.3) min] was noticeably longer than that in group B [(170.9 ± 27.7) min],group C [(154.6 ± 25.0) min],group D [(142.6 ± 32.8) min] and group M [(137.3 ± 27.7) min] (P ＜ 0.05).Besides,the operation time of group B was longer than group D and M (P ＜ 0.05) while the operation time of group C was longer than group M(P =0.026),and there was no significant difference between group D and M (P =0.996).In addition,the blood loss in group A [(304.3 ± 119.0) ml] was significantly more than that of group B [(282.9 ±89.1)ml],group C[(232.9 ±82.2)ml],group D[(202.8 ±72.7)m1] and group M[(200.0 ±70.7)ml] (P ＜ 0.05) whilst the blood loss of group B was markedly more than that of group D and M (P ＜ 0.05),and no significant difference was indicated between group C,D and M(P ＞ 0.05).Moreover,there were 6 cases of blood vessel injury and 7 cases conversion to multi-port VATS in group A,which was evidently more than the other groups(P ＜ 0.05).Furthermore,the pain score of group A was remarkably higher than the other groups (P ＜ 0.05).However,the number of dissected lymph nodes,postoperative complications and chest drainage and hospital stay were similar among all the groups (P ＞ 0.05).Conclusion S-VATS lobectomy for treatment of lung cancer is feasible and effective with learning curve of nearly 70 cases,but it does not demonstrate any advantage compared with M-VATS.
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@#Objective To clearly define and describe the difference of analgesic actions and side effects between dezocine and parecoxib sodium in video-assisted thoracic surgery (VATS) lobectomy. Methods Ninety patients underwent thoracotomy (lobectomy) and were hospitalized in the Department of Thoracic Surgery, West China Hospital, Sichuan University between August 2015 and January 2016. Patients were randomly divided into two groups including a parecoxib sodium group (a PG group, 43 patients) and a dezocine group (a DG group, 47 patients). We analyzed the occurrence of side effects in the two groups, as well as other outcomes including visual analogous scores and location of the pain et al. Results The occurrences of nausea, vomit and abdominal distention in the PG group (9.30%, 2.33%, 13.95%) were significantly lower than those of the DG group (25.53%, 17.02%, 40.43% , P=0.046, P=0.032, P=0.009) in the early period after operation. Pain scores at the postoperative 12 h, 24 h, 48 h and 72 h in the PG group (2.56±0.96, 2.47±0.96, 1.93±0.99, 0.98±1.24) were better than those of the DG group (4.00±1.60, 3.62±1.48, 3.36±1.55, 2.47±1.78, P=0.000, P=0.000, P=0.000, P=0.002). And the same results were found in the postoperative coughing VAS assessment. The mostly reported pain location was the chest drainage, incision site and chest wall in turn. Postoperative pain properties, in turn, were swelling, stabbing pain and numbness. Conclusion Postoperative pain after VATS lobectomy may be adequately controlled using parecoxib sodium. The low pain scores and decreased adverse effects are achieved.
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The actual incidence of multiple thymoma is unknown and rarely reported because it remains controversial whether the cases represent a disease of multicentric origin or a disease resulting from intrathymic metastasis. In this case, a patient underwent total thymectomy for multiple thymoma with myasthenia gravis via bilateral video-assisted thoracic surgery. A well-encapsulated multinodular cystic mass, measuring 57 mm×50 mm×22 mm in the right lobe of the thymus, and a well-encapsulated mass, measuring 32 mm×15 mm×14 mm in the left lobe, were found. Both tumors were type B2 thymoma. Few cases of multiple thymoma with myasthenia gravis have ever been reported in the literature. We report a case of synchronous multiple thymoma associated with myasthenia gravis.
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Humans , Incidence , Myasthenia Gravis , Neoplasm Metastasis , Thoracic Surgery, Video-Assisted , Thymectomy , Thymoma , Thymus GlandABSTRACT
Objective To evaluate the efficacy of decortication by video-assisted thoracic surgery (VATS) in pa﹣tients with tuberculous empyema, and discuss its indications. Methods 60 patients with tuberculous empyema who underwent decortication by VATS for surgical management from December 2010 to December 2015 were included. Under a thoracoscope, we cleaned up the pus, separated adhesions, scraped granulation tissues and caseous necrosis on the inner wall of the abscess cavity, and stripped the thickened fiberboard of the parietal and visceral pleurae. Af﹣ter the procedure, sufficient drainage and antituberculosis therapy were carried out. Results All the patients in this group were operated successfully. All the patients were cured without perioperative death and complications. No re﹣currence of empyema was observed at the follow-up examination from 2 months to 5 years, and suffered pulmonary reexpansions were better. Conclusions The decortication by VATS for tuberculous empyema is safe, effective, mini﹣mally invasive. The imaging manifestations of pleural thickening in 1 cm, no obvious calcification, no serious lesions in the lungs are the indications for the operation.
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BACKGROUND: The aim of this study was to evaluate the feasibility of single-port video-assisted thoracic surgery (VATS) in the treatment of secondary spontaneous pneumothorax (SSP). METHODS: Twenty-four patients who were scheduled to undergo single-port VATS for SSP were studied. The medical records of the patients were retrospectively reviewed. The mean follow-up duration was 26.1+/-19.8 months. In order to evaluate the feasibility of single-port VATS for SSP, the postoperative results of single-port VATS (n=15) in patients with emphysema were compared with those of emphysematous patients who underwent three-port VATS (n=15) during the study period. RESULTS: Single-port VATS was feasible in 19 of 24 patients (79.2%), while an additional port was needed in five patients. In the single-port VATS patients, the median operation time, duration of chest tube drainage, and hospital stay were 84.0 minutes, one day, and two days, respectively. Postoperative complications included prolonged chest tube drainage for more than five days (n=1), wound infection (n=1), and vocal fold palsy (n=1). No recurrence of pneumothorax was observed during the follow-up period. The median operation time, duration of chest tube drainage, and hospital stay of the emphysematous patients who underwent single-port VATS were shorter than those who underwent three-port VATS group (p<0.05 for all parameters). CONCLUSION: Single-port VATS proved to be a feasible procedure in the treatment of patients with secondary spontaneous pneumothorax.
Subject(s)
Humans , Chest Tubes , Drainage , Emphysema , Follow-Up Studies , Length of Stay , Medical Records , Pneumothorax , Postoperative Complications , Recurrence , Retrospective Studies , Thoracic Surgery, Video-Assisted , Vocal Cord Paralysis , Wound InfectionABSTRACT
BACKGROUND: A closed pleural biopsy is commonly performed for diagnosing patients exhibiting pleural effusion if prior thoracentesis is not diagnostic. However, the diagnostic yield of such biopsies is unsatisfactory. Instead, a thoracoscopic pleural biopsy is more useful and less painful. METHODS: We compared the diagnostic yield of needle thoracoscopic pleural biopsy performed under local anesthesia with that of closed pleural biopsy. Sixty-seven patients with pleural effusion were randomized into groups A and B. Group A patients were subjected to closed pleural biopsies, and group B patients were subjected to pleural biopsies performed using needle thoracoscopy under local anesthesia. RESULTS: The diagnostic yields and complication rates of the two groups were compared. The diagnostic yield was 55.6% in group A and 93.5% in group B (p<0.05). Procedure-related complications developed in seven group A patients but not in any group B patients. Of the seven complications, five were pneumothorax and two were vasovagal syncope. CONCLUSION: Needle thoracoscopic pleural biopsy under local anesthesia is a simple and safe procedure that has a high diagnostic yield. This procedure is recommended as a useful diagnostic modality if prior thoracentesis is non-diagnostic.
Subject(s)
Humans , Anesthesia, Local , Biopsy , Needles , Pleural Diseases , Pleural Effusion , Pneumothorax , Syncope, Vasovagal , ThoracoscopyABSTRACT
A 76-year-old male underwent a left upper lobectomy with wedge resection of the superior segment of the left lower lobe using video-assisted thoracoscopic surgery (VATS) for non-small-cell lung cancer of the left upper lobe. He presented with shortness of breath, fever, and leukocytosis. Chest radiography showed atelectasis at the remaining left lower lobe. Bronchoscopy revealed narrowing of the left lower bronchus with purulent secretion, and computed tomography showed downward kinking of the left lower lobar bronchus. He underwent exploratory VATS, and intraoperative findings showed an inferiorly kinked left lower lobar bronchus with upward displacement of the left lower lobe. After adhesiolysis, the kinked bronchus was straightened, and bronchopexy was performed to the pericardium to prevent the recurrence of bronchial kinking. Also, the inferior pulmonary ligament was reattached to prevent upward displacement. Postoperative follow-up bronchoscopy revealed no evidence of residual bronchial obstruction, and chest radiography showed no atelectasis thereafter.
Subject(s)
Aged , Humans , Male , Airway Obstruction , Bronchi , Bronchoscopy , Dyspnea , Fever , Follow-Up Studies , Leukocytosis , Ligaments , Lung Neoplasms , Pericardium , Pulmonary Atelectasis , Radiography , Recurrence , Thoracic Surgery, Video-Assisted , ThoraxABSTRACT
BACKGROUND: Recently, single-port video-assisted thoracic surgery (VATS) has been proposed as an alternative to the conventional three-port VATS for primary spontaneous pneumothorax (PSP). The aim of this study is to evaluate the early outcomes of the single-port VATS for PSP. METHODS: VATS was performed for PSP in 52 patients from March 2012 to March 2013. We reviewed the medical records of these 52 patients, retrospectively. Nineteen patients underwent the conventional three-port VATS (three-port group) and 33 patients underwent the single-port VATS (single-port group). Both groups were compared according to the operation time, number of wedge resections, amount of chest tube drainage during the first 24 hours after surgery, length of chest tube drainage, length of hospital stay, postoperative pain score, and postoperative paresthesia. RESULTS: There was no difference in patient characteristics between the two groups. There was no difference in the number of wedge resections, operation time, or amount of drainage between the two groups. The mean lengths of chest tube drainage and hospital stay were shorter in the single-port group than in the three-port group. Further, there was less postoperative pain and paresthesia in the single-port group than in the three-port group. These differences were statistically significant. The mean size of the surgical wound was 2.10 cm (range, 1.6 to 3.0 cm) in the single-port group. CONCLUSION: Single-port VATS for PSP had many advantages in terms of the lengths of chest tube drainage and hospital stay, postoperative pain, and paresthesia. Single-port VATS is a feasible technique for PSP as an alternative to the conventional three-port VATS in well-selected patients.
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Humans , Chest Tubes , Drainage , Length of Stay , Medical Records , Pain, Postoperative , Paresthesia , Pneumothorax , Retrospective Studies , Thoracic Surgery, Video-Assisted , Wounds and InjuriesABSTRACT
Lobectomy with mediastinal node dissection has been standard treatment for non-small cell lung cancer (NSCLC). Nowadays, video-assisted thoracoscopic surgery (VATS) is gaining acceptance as an alternative treatment option, given the quality-of-life benefits that it confers. For the VATS procedure, most surgeons create two or three ports with a utility incision of 3 to 5 cm. However, with acquired skill and instrumentation advances, single-incision thoracoscopic surgery has emerged over time. Here, we report the case of an 86-year-old female with NSCLC treated by single-incision segmentectomy.
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Aged, 80 and over , Female , Humans , Carcinoma, Non-Small-Cell Lung , Lung Neoplasms , Mastectomy, Segmental , Minimally Invasive Surgical Procedures , Thoracic Surgery, Video-Assisted , ThoracoscopyABSTRACT
Mediastinal paragangliomas are very rare neuroendocrine tumors. Complete resection is the standard treatment of a paraganglioma because of the tumor's potential malignancy and poor response to chemo- or radiotherapy. However, the highly vascular nature of the tumor and its characteristic anatomic location make complete resection difficult. We report a case of an anterior mediastinal paraganglioma, which was incidentally found on a chest computed tomography scan for chronic cough work-up of a 55-year-old woman. Complete resection was accomplished using video-assisted thoracoscopic surgery, and the patient recovered without any complications.
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Female , Humans , Middle Aged , Cough , Mediastinal Neoplasms , Neuroendocrine Tumors , Paraganglioma , Radiotherapy , Thoracic Surgery, Video-Assisted , ThoraxABSTRACT
With advancement of the technique of video-assisted thoracic surgery (VATS), some surgeons have made great efforts to reduce the number of incisions in the conventional three- or four-port approach. Several studies on cases treated by single-incision VATS and their short-term outcomes were reported. Here, we present our experience with single-incision VATS for the treatment of benign mediastinal diseases.
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Mediastinal Diseases , Minimally Invasive Surgical Procedures , Thoracic Surgery, Video-AssistedABSTRACT
In this article, we report a rare case of a 22-year-old male with bilateral pulmonary sequestration, treated with embolization and surgical resection. The initial plan involved staged bilateral lobectomy for both lungs and prophylactic embolization of feeding vessels for preventing unexpected hemorrhage during operation. Symptomatic right lower lobe was resected with video-assisted thoracic surgery after embolization, and the patient refused surgery of left lower lobe upon symptomatic relief. The two-year follow-up examination revealed that the patient was healthy and had no relevant discomfort.
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Humans , Male , Young Adult , Bronchopulmonary Sequestration , Follow-Up Studies , Hemorrhage , Lung , Thoracic Surgery, Video-AssistedABSTRACT
BACKGROUND: Video-Assisted Thoracic Surgery can be performed with the lung collapsed. During the procedure, pleural adhesion may result in lung injury, bleeding, and thoracotomy conversion. Identifying the presence of pleural adhesion before surgery can make it easy to plan trocar introduction and perform the procedure. MATERIAL AND METHOD: Between June 2009 and November 2009, we performed ultrasound in 24 patients to detect pleural adhesion before surgery and compared the results with the operative findings. We primarily examined the lateral chest, where the trocar would be inserted, and, occasionally, the anterior or posterior chest. RESULT: Patient diseases were: 6 hyperhidroses, 8 interstitial lung diseases, 5 lung cancers, 2 mediastinal tumors, 1 peripheral pulmonary embolism, 1 metastatic lung cancer, and 1 sarcoidosis. Of the 22 patients who did not have pleural adhesions on ultrasound, four revealed mild adhesions not related to the trocar insertion sites. However, ultrasound showed pleural adhesions in two patients, consistent with the operative findings. There was no air leak or thoracotomy conversion related with trocar insertion. CONCLUSION: Ultrasound requires only a few minutes to detect the presence of the pleural adhesion and was very useful in identifying the pleural adhesion before VATS.
Subject(s)
Humans , Hemorrhage , Lung , Lung Diseases, Interstitial , Lung Injury , Lung Neoplasms , Pulmonary Embolism , Sarcoidosis , Surgical Instruments , Thoracic Surgery, Video-Assisted , Thoracotomy , ThoraxABSTRACT
BACKGROUND: Pleural symphysis is regarded as an important treatment option in reducing recurrence rates after surgical treatment of spontaneous pneumothorax. However, there is much debate over the best method for achieving pleural symphysis. We retrospectively compared apical pleurectomy (AP) with mechanical pleural abrasion (MPA). MATERIAL AND METHOD: Between January 2000 and December 2007, 83 patients underwent video-assisted thoracoscopic surgery (VATS) for spontaneous pneumothorax. In addition to wedge resection of bullae, MPA was performed in 21 patients (group A) and AP in 62 patients (group B). RESULT: There were no significant differences in age, gender and site of pneumothorax between the two groups. Operative time was 97+/-44 minutes in group A and 77+/-18 minutes in group B (p>0.05). The mean amount of pleural drainage through the chest tube on the first postoperative day was 156+/-87 cc in group A and 147+/-87 cc in group B (p>0.05). There was no mortality or significant morbidity in all patients with the exception of reoperation for bleeding in two patients in group B. In the postoperative course, there were no statistical differences between the two groups in the rate of residual air space, air leak and indwelling time of chest tube, and hospital stay. Mean follow up time was 31.7+/-25.3 months, and the recurrence rate of pneumothorax was 9.5% (2/21) in group A and 6.5% (4/62) in group B, without statistical significance. CONCLUSION: AP was no more advantageous than MPA in terms of operative time, postoperative course and prevention of recurrent pneumothorax. Therefore, complete resection of bullae and existence of residual bullae are more important factors in reducing the incidence of recurrent pneumothorax than pleural symphysis.