Sub-axillary cosmetic incision VS single-incision thoracoscopic surgery for primary spontaneous pneumothorax

Abstract

Abstract Background Recently, single-incision thoracoscopic surgery (SITS) has gained attention as an optimal treatment for the primary spontaneous pneumothorax (PSP). However, most SITS techniques use in the fourth to sixth intercostal space between the anterior axillary and mid axillary lines. To find out more concealed incisions, this study performed PSP surgery with the sub-axillary cosmetic incision (SACI) technique. Methods A total of 128 patients with PSP underwent video-assisted thoracoscopic surgery (VATS) at our institution between January 2017 and January 2019. These patients were evaluated and divided into SACI (n = 21) and SITS group (n = 57). Propensity score matching (PSM) was performed based on the patient’s backgrounds, and the enrolled cohort was divided into 21 pairs. The incision satisfaction was analyzed at 2 weeks and 6 months post-surgery. Results Twenty-one pairs with baseline characteristics matched into the two groups had no significant differences in their backgrounds and surgical results. However, the operation time was longer in the SACI group than in the SITS group (p = 0.013). There were no post-operative complications found in both groups. The incision satisfaction score in the SACI group was lower than the SITS group at 2 weeks and 6 months, and the difference was statistically significant (respectively, p = 0.022 and p = 0.039). There were no recurrences of ipsilateral pneumothorax in both groups. Conclusions SACI is a safe and feasible surgical method for the treatment of PSP. In addition, incision concealment can be used based on the choice for patients with incision needs.