Awake Thoracoscopic Treatment of Spontaneous Pneumothorax
Pp. 130-140 (11)
Gianluca Vanni, Federico Tacconi, Tommaso Claudio Mineo and Eugenio Pompeo
Spontaneous Pneumothorax (SP) is a relatively common condition defined as the presence of
air in the pleural space associated with lung collapse.
On an etiologic basis, pneumothorax is classified as spontaneous, traumatic and iatrogenic. The term
“spontaneous” indicates that no mechanical injury is recognized as the causative mechanism whereas
secondary SP occurs as an acute complication of an underlying lung disease.
The principal goal of treatment is to evacuate air from the pleural space and achieve lung reexpansion.
Simple chest drainage is often employed as first line treatment, whereas bullectomy performed by
Video-Assisted Thoracic Surgery (VATS) is widely adopted for treatment of recurrent SP. Pleurodesis
by pleurectomy or talc insufflation is also commonly associated to bullectomy to reduce risks of
VATS is usually carried out through general anesthesia and one lung ventilation, although use of this
type of anesthesia can be associated with several adverse effects. Recently, VATS management of SP
has been performed with satisfactory results by local anesthesia in spontaneously ventilating patients. In
particular, we have began a clinical investigational program entailing VATS bullectomy and
pleurectomy performed through sole Thoracic Epidural Anesthesia (TEA) in fully awake patients. In
this chapter we describe technical features and results of this novel surgical approach.
Pneumothorax, VATS, thoracic epidural anesthesia.
Department of Thoracic Surgery, Emphysema Center, Policlinico Tor Vergata University, Rome, Italy.