Pneumothorax is an abnormal collection of air inside the pleural space. It is mostly associated with emphysema, asthma, and tuberculosis. It may be spontaneous, traumatic, or iatrogenic.
Primary spontaneous pneumothorax (PSP) occurs in young, otherwise, healthy adults without clinically apparent lung disease; while secondary spontaneous pneumothorax (SSP) is a complication of pre-existing lung disease, most commonly chronic obstructive pulmonary disease (COPD).
With the advent of high-resolution computed tomography (HRCT), the PSP has come to be better understood and managed. Its etiology can now be identified in the majority of cases. PSP is mainly caused by rupture of a small subpleural emphysematous vesicle (designated a bleb) or of a subpleural paraseptal emphysematous lesion (designated a bulla).
Generally, spontaneous pneumothorax is managed surgically in the second attack or in selected patients with the first episode. The surgical approach is the best treatment to minimize the risk of recurrence. There is substantial evidence in the literature demonstrating that the minimally invasive approach is preferred to the thoracotomy procedure since it can reduce the postoperative pain and it is associated with a faster recovery of the physical and work activity.
VATS approach has been shown to offer greater advantages regarding postoperative pain and postoperative respiratory function when compared to thoracotomy incision.