22 MED ARH 2010; 64(1) • ORIGINAL PAPERS 1. INTRODUCTION Pneumothorax (PNTX) is the pres- ence of air in the pleural cavity. It is as- sociated with a partial or a complete collapse of the afected lung. It is said that pneumothorax is spontaneous in the absence of traumatic or jatrogenic factors (punction, catheterization, ven- tilation, biopsy) (1). Primary spontaneous pneumotho- rax (PSP) is characterized by the ab- sence of clinically and radiologically recognizable lesions. his is the cause of one or several bladders ruptures (bul- lae).he development of computerized tomography in the last decades enabled a better appraisal of anatomic lesions frequency, which are associated with the spontaneous pneumothorax (2). he evolution of spontaneous pneumotho- rax is mostly benign, but it is marked with a lot of frequent recurrences which require a surgical treatment (3). horacoscopy is an old surgical pro- cedure. It is often used for diagnostic purposes. he evaluation of video ma- terials and surgical instruments, and mastering technics of selective intuba- tion in anaesthesia, gave this procedure the option of therapy treatment (4). he surgical treatment of pneumo- thorax enables the rexpansion of lung parenchyma and normalization of lung function. It blocks the development of recurrence with a minimal hospital- ization. Video-assisted thoracoscopic sur- gery (VATS) has an aim to realize endo- thoracoscopic procedures, which are usually done by thoracotomy through the holes of size 1-2 cm (5,6). he treat- ment by video-assisted thoracoscopic surgery (VATS) is performed under a general anaesthetic including the selec- tive intubation and it consists of three stages: the exploration, the treatment of bullae and pleurodesis. he aim of this study was to determine and compare the pain intensity, the length of surgi- cal procedure, the number and type of postsurgical complications in patients treated with VATS, in relation to pa- tients treated with thoracotomy. 2. PATIENTS AND METHODS • his is a retrospective research in- cluding 100 patients with a spon- taneous pneumothorax. he pa- tients are divided into two groups: • he irst group of 50 patients have been operated with VATS • he second group of 50 patients have been operated with thora- cotomy From January 1998 to January 2003, out of 134 patients who have been treated with VATS, because of primary spontaneous pneumothorax (PSP), at the Clinic for Chest Surgery the Uni- versity Hospital in Strasbourg, the 50 patients were chosen at random. he patients were treated under general an- aesthetic including the selective intuba- tion vith the Carlens tube. he patients with ASA III and ASA IV risk group were excluded. At the Department of Chest Sur- gery UKC in Tuzla, from January 1998 to January 2005, out of 107 treated pa- tients, 50 patients were chosen at ran- dom. hey were treated with the stan- dard thoractomy because of the pri- mary spontaneous pneumothorax (PSP). he patients were treated under general endotrachaetomic including the selective intubation with the Car- lens tube. he patients with ASA III and ASA IV risk group were excluded. In this study histories of disease were used. The patients from both groups were very similar considering profession, age, gender, smoking habits, the ethiology of pneumothorax and the appearance of bullae. All patient diag- nosis is set based on clinical examina- tion, chest radiography and conirmed by CT. All patients was done by the same surgical procedure on the lung pa- renchyma.We determined the length of surgical procedure, the pain intensity, the number and the type of postsurgi- cal complications. he statistical analysis results, we used the following tests: t-test, Mann- Whitney, Wilcoxon W, Kolmogorov- Smirnov Z and X² test. Statistical hypotheses were tested at the level of α=0,05. Video-Assisted Thoracoscopic Surgery for Spontaneous Pneumothorax Nusret Ramic, Goran Krdzalic, Deso Mesic, Zlatan Aljic, Nermin Musanovic Department of Surgery, University Clinical Center Tuzla, Bosnia and Herzegovina ORIGINAL PAPER SUMMARY Primary spontaneous pneumothorax (PSP) is a benign disease frequently found in younger and healthy-looking persons. It requires a surgical treatment in about 30-40% of cases. Video-assisted thoracoscopic surgery (VATS) has been recently introduced as a reliable alternative method to the classic thoracoto- my. The aim of this paper is to establish and compare the length of surgical procedure, pain intensity, number and kind of postsurgi- cal complications during the procedure for the patients with PNTX treated by VATS in relation to the patients with PNTX treated by thoracotomy. This is a retrospective study. The patients are divided into two groups: the irst group of 50 patients treated with VATS and the second group of 50 patients treated with thoracotomy. The results obtained show a signiicantly shorter surgery duration in the group of the patients treated with VATS in relation to the group of patients treated by thoracotomy (p‹0,001). Video-assisted thoracoscopic surgery is characterized by a signiicantly low intensity of postsurgical pain in relation to thoracotomy (p‹0,001). The number and kind of postsurgical com- plications are similar in both target groups (p›0,05). Only one relapse occurred in the VATS group. Video-assisted thoracoscopic surgery improves patients’ life quality in relation to the thoracotomy patients. The patients return to work, or to sport activities after a very short time because of minimal sequels. That is why this method represents an obvious socio-economic interest. Today, in the era of a great video-development, VATS method is a treatment of choice for PSP. Keywords: spontaneous pneumothorax, VATS, thoracotomy