Minithoracotomy with Simultaneous Video-assisted Thoracoscopic Surgery vs. Video-assisted Thoracoscopic Surgery for Spontaneous Hemopneumothorax

Background: Spontaneous hemopneumothorax, a life-threatening and rare disorder and complication of primary spontaneous pneumothorax, is regarded as a surgical emergency. We have prospectively investigated the differences in safety and utility between minithoracotomy with simultaneous video-assisted thoracoscopic surgery (MT+VATS) and the video-assisted thoracoscopic surgery approach (VATS) in the treatment of spontaneous hemopneumothorax. Methods: From Jan 1998 to May 2002, 248 patients with primary spontaneous pneumothorax were treated in our hospital. Among these patients, 12 (4.8%) spontaneous hemopneumothorax occurred, all in the first episode of spontaneous pneumothorax. After tube thoracostomy, the amount of blood drainage ranged from 500 to 1,500 ml. 8 patients were treated by MT+VATS and 4 by VATS. Results: During surgery, the sources of hemorrhage were all from the torn aberrant vessels between the apical blebs and the parietal pleura. The duration of main surgical procedure (including removal of blood clot in pleural cavity, control of bleeding and blebectomy) was significantly shorter in MT+VATS than in VATS (p<0.01, Mann-Whitney U). There were no differences between these two groups in postoperative chest tube drainage duration, average postoperative pain score or hospital stay. No relapses occurred in the succeeding 6 months to 4 years. Conclusions: Spontaneous hemopneumothorax is usually treated as an urgent surgical condition. MT+VATS is an easy accessible and safe procedure that could be applied as an initial treatment method in the patient with spontaneous hemopneumothorax, especially in the treatment of the patients with active hemorrhage and massive blood clot in the thorax.