Pii: S1010-7940(99)00142-6

Objectives: Video-assisted thoracoscopic surgery (VATS) is generally recognized as a less invasive method than thoracotomy. However, the in ̄uence of VATS on postoperative pulmonary gas exchange has yet to be evaluated. Methods: Thirty eight patients with spontaneous pneumothorax were randomized into bullectomy by VATS (n ˆ 20) or axillary thoracotomy (n ˆ 18). Gas exchange was assessed by using hot wire mass spectrometer, and blood gas analysis preoperatively and postoperatively at 1, 3, 6, 12, 24, and 48 h and on days 4 and 6. Post operative pain control was managed by continuous epidural morphine injection and administration of diclofenac sodium orally or suppository. Postoperative atelectasis was assessed by daily chest roentgenograms. Results: VATS patients had continuously higher PaO2 than axillary thoracotomy at 12, 48 h and day 4 postoperatively (P , 0:05). Alveolar-arterial oxygen tension gradient in VATS patients was signi®cantly less than that in patients with axillary thoracotomy from the 6th h throughout to the 4th day postoperatively (P , 0:01). Use of postoperative analgesics and the incidence of peripheral atelectasis were more frequent in patients with axillary thoracotomy. Conclusions: Bullectomy via VATS was less deleterious to pulmonary gas exchange. Axillary thoracotomy caused worsening of gas exchange postoperatively due to incisional pain, chest wall deformity, and peripheral atelectasis. q 1999 Elsevier Science B.V. All rights reserved.