Reason for the Surgery

With reference to professional medical literature and the recommendations of the medical associations, patients with spontaneous pneumothorax who meet any of the following conditions are recommended for surgical treatment.

• Patients with recurrent ipsilateral pneumothorax.
• A progressive collapse of the lung lobes due to air leakage.
• Imaging examination clearly shows that the bubble formation has been clinically complicated.
• Combined with hemothorax(spontaneous hemopneumothoax).
• Suspected to have other causes or secondary pneumothorax.
• Conservative treatment results are not satisfactory.
• Operations may also be performed on the first episode of the disease for special occupational, work or personal considerations.

Steps and Scope of Surgery

• General anesthesia is required during the operation, and thoracoscopy is used to detect and operate the contralateral lung when breathing under special double-tube endotracheal tube control.
• The above-mentioned thoracoscopic surgery should be performed with 2 to 3 incisions on the ipsilateral side of the chest wall. They will be all less than 1 cm
• Pulmonary bullae that are expected to burst will be removed during the procedure and pleurodesis will be performed to reduce the chance of recurrence.
• After the operation, a drainage thoracic tube must be inserted into the pleural cavity for aspiration to facilitate the discharge of excess thin blood and air.

Expected Surgery Success Rates

• Thoracoscopic surgery in nowadays is a safe and less invasive new technique. Unless the patient is susceptible to unpredictable factors such as allergy to anesthetic drugs, arrhythmias, or excessive tracheal contraction, there is rarely the possibility of fatal complications.
• In general, the complication rate after surgery is less than 10%, while the recurrence rate of pneumothorax can be controlled under 5%.

Possible Symptoms Expected after Surgery

• Depending on the patient's condition, only very few patients with dyspnea will be transferred to an intensive care unit to facilitate the smooth recovery of respiratory function.
• The recovery rate of the patient is reliant on respiratory rehabilitation after surgery. Although patients may experience symptoms such as wound pain, difficulty breathing, fever or difficulty expectorating sputum, only the cooperation from patients, family members and all medical staff is the best guarantee for the smooth recovery after surgery.

Possible Complications, Risks and Management

• Very few patients may develop severe complications such as shock because they are allergic to anesthetic agents.
• Respiratory rehabilitation after an operation is very important, especially for heavy smokers, the elderly with emphysema, those with poor nutrition and difficulty breathing, and those who suffer from sputum obstruction due to intolerable wound pain. As a result, they may need ventilator support treatment in the intensive care unit due to insufficient alveolar ventilation leading to lung collapse, bronchial obstruction, fever, pneumonia and even respiratory failure.
• A few patients may have accumulated blood or fluid in the space of pleural cavity after operation, which may lead to hemothorax or empyema and require drainage for an extended period of time.
• Complications such as wound infection, aspiration pneumonia, pressure ulcer, upper gastrointestinal bleeding and septicaemia may occur in patients with different health conditions.

Possible Consequences if Surgery is not Performed

• Persistent pneumothorax can trigger lung collapse, leading to pneumonia, pulmonary abscess, empyema, hemothorax, and even pulmonary fibrosis.
• Some patients develop a pressure pneumothorax or pneumohemothorax that requires emergency surgery to relieve.

Alternatives to Surgery

The treatment of pneumothorax includes observation, air aspiration, thin tube drainage, and thoracic tube insertion and drainage, but all have the disadvantages of recurrent attacks. Therefore, for patients prone to recurrence or with individual considerations, it is generally advised to choose thoracoscopic surgery for treatment once and for all.