BMJ, doi: 10.1136/bmj.38243.440486.55, (Published 22 September 2004)

PAPERS

Video assisted thoracic surgery for treatment of pneumothorax and lung resections: systematic review of randomised clinical trials

Artyom Sedrakyan 1, Jan van der Meulen 1, James Lewsey 1, Tom Treasure 2

1 Health Services Research Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT
2 Cardiothoracic Unit, Guy's Hospital, London SE1 9RT

Objectives To determine if video assisted thoracic surgery is associated with better clinical outcomes than thoracotomy for three common procedures: surgery for pneumothorax, minor resections, and lobectomy.

Design Systematic review of randomised clinical trials.

Data sources Medline, Embase, Cochrane database of systematic reviews, Cochrane controlled trials register. Reference lists of relevant articles and reviews.

Methods Criteria for inclusion were random allocation of patients and no concurrent use of another experimental medication or device. At least two authors performed and confirmed data abstraction and analyses. Information on quality of trials, demographics, frequency of the events, and numbers randomised were collected.

Results 12 trials randomised 670 patients. Video assisted thoracic surgery was associated with shorter length of stay (reduction ranged from 1.0 to 4.2 days) and less pain or use of pain medication than thoracotomy in the five out of seven trials in which the technique was used for pneumothorax or minor lung resection. In the treatment of pneumothorax, video assisted thoracic surgery was associated with substantially fewer recurrences than pleural drainage in two trials (from 20 to 53 events prevented per 100 treated patients). No substantial advantages were observed for video assisted thoracic surgery in lobectomies.

Conclusions Video assisted thoracic surgery is associated with better outcomes and seems to have a complication profile comparable with that of thoracotomy for the treatment of pneumothorax and minor resections. As for lobectomy, further studies are needed to determine how it compares with thoracotomy.

(Accepted 13 August 2004)
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  • Malik, M., Black, E. A. (2009). Fast-track video-assisted bullectomy and pleurectomy for pneumothorax: initial experience and description of technique. Eur. J. Cardiothorac. Surg. 36: 906-909 [Abstract] [Full text]  
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  • Solli, P., Spaggiari, L. (2007). Indications and Developments of Video-Assisted Thoracic Surgery in the Treatment of Lung Cancer. The Oncologist 12: 1205-1214 [Abstract] [Full text]  
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  • Currie, G. P, Kennedy, A.-M., Paterson, E., Watt, S. J (2007). A chronic pneumothorax and fitness to fly. Thorax 62: 187-189 [Abstract] [Full text]  
  • Sedrakyan, A., Wu, A. W., Parashar, A., Bass, E. B., Treasure, T. (2006). Off-Pump Surgery Is Associated With Reduced Occurrence of Stroke and Other Morbidity as Compared With Traditional Coronary Artery Bypass Grafting: A Meta-Analysis of Systematically Reviewed Trials * Supplemental Appendix I. Stroke 37: 2759-2769 [Full text]  
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  • Reddy, R V (2005). The advantages of VATS: a systematic review. Thorax 60: 238-238 [Full text]  

Rapid Responses:

Read all Rapid Responses

VATS in the treatment of Empyema- why was this omitted from your review?
Harsh Grewal
bmj.com, 29 Oct 2004 [Full text]
Re: VATS in the treatment of Empyema- why was this omitted from your review?
Tom Treasure
bmj.com, 30 Oct 2004 [Full text]
Does video assisted thoracoscopic surgery have clear advantages over thoracotomy?
C S Pramesh, et al.
bmj.com, 10 Nov 2004 [Full text]
How strong is the evidence?
John P Duffy
bmj.com, 30 Nov 2004 [Full text]
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