Reduced inflammatory response in minimal invasive surgery of pneumothorax

F. T. Gebhard, H. P. Becker, H. Gerngross and U. B. Bruckner
Department of Surgery, German Military Hospital, Ulm, Germany.

OBJECTIVE: To elucidate whether thoracoscopy for surgical therapy of pneumothorax leads to a reduction of inflammatory responses in comparison with standard thoracotomy. DESIGN: A prospective randomized study PATIENTS: Eleven patients (9 men and 2 women; median age, 28 years; range, 21-44 years) were treated by thoracotomy; 10 patients (9 men and 1 woman; median age, 26 years; range, 21-28 years) were managed thoracoscopically. The plasma concentrations of the following were determined: polymorphonuclear granulocyte elastase and C-reactive protein as inflammatory parameters and prostanoids (prostacyclin, thromboxane A2, prostaglandin F2 alpha, prostaglandin M, and prostaglandin E2) as vasoactive parameters. Blood sampling was performed perioperatively and on day 3 after surgery. RESULTS: The thoracoscopy group revealed a shorter hospital stay (5 vs 7 days; P < .05) and a significantly reduced need for intravenous pain medication within 48 hours (1 vs 3 requirements; P < .01) vs the thoracotomy group. The release of inflammatory (C-reactive protein, P < .01) and vasoactive (prostacyclin and thromboxane A2, P < .01) mediators was less during thoracoscopy compared with standard thoracotomy. CONCLUSIONS: The thoracoscopic procedure is less invasive when performing wedge resection of apical blebs. With intracavitary management being equivalent to the conventional technique, the curtailed morbidity after thoracoscopic surgery is considered to be related to the minimal trauma associated with the access to lung tissue and the reduced handling of lung tissue.