Thoracoscopy for spontaneous pneumothorax

Spontaneous pneumothorax is a relatively common disease with an incidence for primary spontaneous pneumothorax (PSP) of 18–28/100,000 per year in males and 1.8–6/100,000 per year in females (Henry et al. 2003) and rates for secondary spontaneous pneumothorax (SSP) of 6.3/100,000 in males and 2.0/100,000 in females (Melton et al. 1979). Despite the publication of numerous national and international guidelines, there remains debate over the best way to manage both primary and secondary pneumothorax. After a first episode of primary pneumothorax, the 5-year recurrence rate without pleurodesis/pleural abrasion is 30–50 % (Sadicot et al. 1997). Debate remains over the best time for a definitive procedure to prevent recurrence and indeed what the best form of intervention is either apical pleurectomy/pleural abrasion +/- bullectomy via VATS or thoracotomy or medical thoracoscopy with talc poudrage. Medical thoracoscopy can be a safe and effective method for offering recurrence prevention, but is not widely accepted. Current UK guidelines do not include medical thoracoscopy for definitive recurrence prevention of PSP (Henry et al. 2003).