Feasibility of thoracoscopic pulmonary bullectomy using a transareolar approach for treatment of primary spontaneous pneumothorax

Background: Primary spontaneous pneumothorax (PSP) is a common disease among young patients, particularly men. While the most common thoracoscopic approach is triportal, the transareolar approach is rare. In this study, we prospectively investigated the feasibility of thoracoscopic pulmonary bullectomy using a transareolar approach for treatment of PSP. Methods: Ten patients with PSP who underwent thoracoscopic transareolar pulmonary bullectomy were prospectively enrolled in this study between September 2017 and March 2018. For all 10 patients, we evaluated the perioperative outcomes, postoperative complications, recurrence, wound-related pain, and cosmetic satisfaction regarding the surgical wound. Results: The mean patient age was 18.9 +/- 4.2 years; three patients were affected on the right side and seven patients were affected on the left side. Bullae and blebs were localized at the apex of the affected lung in all patients. All procedures were completed using a transareolar approach without additional ports or conversion to thoracotomy in any patient. The mean operative time was 39.8 +/- 8.6 min. The mean volume of blood lost during surgery was extremely small in all patients. The duration of postoperative drainage was 1 day, while the length of postoperative hospital stay was 2 days in all patients. No morbidities or recurrence of PSP occurred during the study period. The mean cosmetic satisfaction scores of the surgical wound were 3.3 and 3.2 on postoperative day (POD) 7 and at postoperative month (POM) 12. The mean NRS score was 1.5 on POD 7. All patients were pain-free at POM 12. Conclusions: Transareolar thoracoscopic pulmonary bullectomy for treatment of PSP is feasible and safe, with a high degree of satisfaction for postoperative pain and cosmetics. This new approach could be a novel option for surgical treatment of PSP.