Open thoracotomy versus video-assisted thoracoscopic surgery for the treatment of spontaneouspneumothorax: which is better?

Introduction: Primary spontaneous pneumothorax results from the spontaneous rupture of an apical subpleural bleb, commonly seen in smokers, predominantly affecting young, thin, and tall men without underlying pulmonary diseases. In contrast, secondary spontaneous pneumothorax affects older individuals with underlying pulmonary diseases such as emphysema, asthma, infections, among others. Objective: To compare, based on scientific evidence found in the literature, open thoracotomy and video-assisted thoracoscopic surgery in the treatment of patients with spontaneous pneumothorax. Method: A comprehensive literature review was conducted using data obtained from the PubMed, Medline (Virtual Health Library), and Scopus databases, selecting articles published between 2019 and July 2024, in English, excluding duplicate and irrelevant studies. Result: After identifying 79 studies, removing 13 duplicates, and completing the entire screening process, 11 relevant articles were included in this review. These articles revealed that open thoracotomy is associated with a lower recurrence rate, while videoassisted thoracoscopic surgery proved to be safer, more effective, less invasive, and provides better aesthetic outcomes. Conclusion: Open thoracotomy and video-assisted thoracoscopic surgery are both surgical procedures used in the treatment of spontaneous pneumothorax, with the choice between them depending on the specific characteristics of each case and the particular advantages of each technique.