A video assisted thoracoscopic (VATS) pleurodesis and bullectomy is a minimally invasive procedure to treat patients with spontaneous pneumothorax. This procedure is performed under general anesthesia with lung isolation. The patient is positioned on the table on their side. Three (1 to 1.5 cm) incisions are made on the chest wall to perform the procedure. The lung is isolated and blebs are identified. All adhesions are taken down between the lung and the pleura. A wedge resection of the blebs or bullae are performed using a thoracoscopic stapler. Next, mechanical pleurodesis of the pleural cavity including diaphragmatic surface is performed. One to two chest tubes are placed in the pleural space to drain the air and fluid.
VATS pleurodesis and bullecotomy is a safe and effective treatment for spontaneous pneumothorax. However, if it is not possible to remove all of the blebs and bullae, your surgeon may need to make the prudent decision to continue by making the traditional incision to safely complete the operation. This should not be seen as a failure, but as a wise decision by your surgeon to prevent dangerous complications. Other complications include bleeding and injury to the lung. There is a small possibility to require a blood transfusion for this operation. There are also a rare complication of injury to the phrenic nerve, diaphragm and pericardium. There is very rare chance of dying from the procedure.
After the operation, most patients will wake up with one to two chest tube on the side of the operation. These will be removed once there is minimal drainage and no air leak. You will be in the hospital to recover from the operation for 1-3 days. Once the chest tubes are removed and your pain is well controlled on oral pain medication, you will be discharged home.
Long Term Outcome
Most of the patients will have resolution of pneumothorax after the procedure and they will not require additional therapy. The chance of recurrence of the pneumothorax after the procedure is 1-5%.