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Video-assisted thoracic surgery for pneumothorax: republication of a systematic review and a proposal by the guideline committee of the Japanese Association for Chest Surgery 2014

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Abstract

Objective

The purpose of this consensus conference was to determine whether video-assisted thoracic surgery (VATS) improves clinical outcomes compared with conventional thoracotomy in patients undergoing surgery for pneumothorax, and to outline evidence-based recommendations for the use of VATS.

Methods

Before the consensus conference, the best available evidence was reviewed, with systematic reviews, randomized trials, and nonrandomized trials all taken into consideration in descending order of validity and importance. At the consensus conference, evidence-based interpretative statements were created, and consensus processes were used to determine the ensuing recommendations. The Medical Information Network Distribution Service in Japan (Minds) system was used to label the levels of evidence for the references and the classes of recommendations.

Results and recommendations

The consensus panel agreed upon the following statements and recommendations for patients with pneumothorax undergoing surgery:

  1. 1.

    VATS is broadly indicated as surgery for pneumothorax.

  2. 2.

    VATS is judged to be less invasive, as it results in minimal postoperative pain, the periods of chest tube placement and hospitalization are short, and it shows a trend toward early realization of social integration.

  3. 3.

    There is no difference in terms of safety and complications between VATS and open thoracotomy.

  4. 4.

    As it is anticipated that VATS will result in a higher recurrence rate than open thoracotomy, it may be desirable to add a supplemental procedure during surgery.

In summary, VATS can be recommended as pneumothorax surgery (Recommendation grade: Level B).

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Abbreviations

VATS:

Video-assisted thoracic surgery

RCT:

Randomized controlled trial

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Conflict of interest

The authors have no competing interests to declare.

Author information

Authors and Affiliations

  1. Guidelines Committees of Japanese Association for Chest Surgery, Kyoto, Japan

    Taichiro Goto, Yoshihisa Kadota, Takeshi Mori, Shin-ichi Yamashita, Hirotoshi Horio, Takeshi Nagayasu & Akinori Iwasaki

  2. Division of General Thoracic Surgery, Department of Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo, 160-8582, Japan

    Taichiro Goto

  3. Department of General Thoracic Surgery, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan

    Yoshihisa Kadota

  4. Department of Thoracic Surgery, Kumamoto University Hospital, Kumamoto, Japan

    Takeshi Mori

  5. Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan

    Shin-ichi Yamashita & Akinori Iwasaki

  6. Department of General Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Tokyo, Japan

    Hirotoshi Horio

  7. Division of Surgical Oncology, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

    Takeshi Nagayasu

Authors
  1. Taichiro Goto
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  2. Yoshihisa Kadota
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  3. Takeshi Mori
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  4. Shin-ichi Yamashita
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  5. Hirotoshi Horio
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  6. Takeshi Nagayasu
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  7. Akinori Iwasaki
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Corresponding author

Correspondence to Taichiro Goto.

Additional information

This article is based on a study first reported in “Clinical Guidelines of Endoscopic Surgery, 2nd Edition, Wiley-JAPAN, Tokyo (Japanese, in press)”.

This review was submitted at the invitation of the editorial committee.

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Goto, T., Kadota, Y., Mori, T. et al. Video-assisted thoracic surgery for pneumothorax: republication of a systematic review and a proposal by the guideline committee of the Japanese Association for Chest Surgery 2014. Gen Thorac Cardiovasc Surg 63, 8–13 (2015). https://doi.org/10.1007/s11748-014-0468-9

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  • DOI: https://doi.org/10.1007/s11748-014-0468-9

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