Spontaneous pneumothorax in women. Team approach of thoracic surgeons and gynecologists

The objective: to implement the non-intubated treatment of pneumothorax in women and its inclusion in the protocol of Enhanced Recovery After Surgery (ERAS).Materials and methods. Surgical treatment using non-intubated video-assisted thoracic surgery (NIVATS) in 30 women with an average age of 38.56 ± 11.32 years (18–69 years) with spontaneous pneumothorax was analyzed. Most of the patients had a first episode of pneumothorax (90%), 3 people had a recurrent episode.All patients were operated by the method of non-intubated uniportal video-assisted thoracic surgery (NI-UVATS) with thoracic epidural anesthesia (TEA) as the main method of analgesia in the postoperative period. The average time to surgery was 1.5 days (0–5 days).Pathohistological studies confirmed the etiology of pneumothorax: bullous disease, thoracic endometriosis. Patients with confirmed thoracic endometriosis were referred to a gynecologist for consultation. The observation period was 48 months.Results. All patients underwent operative treatment and were satisfied with the NIVATS operation. The level of pain intensity according to the visual analogue scale was 1–2 points. The recurrence rate after NI-VATS surgery was 6.7% (2 patients) with confirmed thoracic endometriosis during the use of combined estrogen and progesterone hormone pills, the recurrences occurred after stop of hormonal treatment.Conclusions. Non-intubated video-assisted thoracic surgery for spontaneous pneumothorax in women can be considered a safe and effective treatment and as part of enhanced recovery after surgery (ERAS). Long-term follow-up and further clinical studies are needed to confirm the benefits of the proposed approach.