***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: Surgical treatment of  spontaneous pneumothorax  can be done through a thoracotomy or a video-thoracoscopic approach . Although the videothoracoscopic technique is currently popular it is not obviously superior to a more traditional axillary thoracotomy approach . We compared our recent experience with both techniques to determine the optimal surgical treatment for spontaneous pneumothoraces . A retrospective review of 79 patients treated surgically ( 34 thoracotomy and 45 thoracoscopy ) for spontaneous pneumothoraces was done . Patients were treated between 1991 and 1997 . Patients older than 60 years of age and those with spontaneous pneumothoraces secondary to generalized pulmonary emphysema were excluded . There were no operative deaths . Recurrence rate [ thoracotomy , two of 34 ; thoracoscopy , three of 45 ( P < 0.89 ) ] , air leak exceeding 7 days [ thoracotomy , three of 34 ; thoracoscopy , three of 45 ( P < 0.73 ) ] , operating room times [ thoracotomy , 54 + /- 26 minutes ; thoracoscopy , 53 + /- 16 minutes ( P < 0.59 ) ] , and postoperative length of stay [ thoracotomy , 5.7 + /- 4.3 days ; thoracoscopy , 4.7 + /- 4.4 days ( P < 0.26 ) ] were not significantly different for the two techniques . We conclude that axillary thoracotomy and videothoracoscopy are equally effective surgical treatments for spontaneous pneumothoraces . A large r and omized trial would be needed to determine whether one approach is truly superior to the other The aim of the present study was to determine the impact of various pleurodesis procedures on post-operative morbidity and late recurrence rate after surgical treatment of V and erschueren ’s stage III primary spontaneous pneumothorax . Between January 2001 and June 2004 , 208 consecutive patients ( 169 male and 39 female ; mean ( range ) age 25 ( 12–39 ) yrs ) were su bmi tted to 220 video-assisted thoracoscopic surgical procedures for primary spontaneous pneumothorax . All patients underwent apical lung resection ; 112 were assigned at r and om to mechanical pleural abrasion ( group A ) and 108 to apical pleurectomy ( group B ) . The two groups of patients showed similar characteristics . No intra- or post-operative deaths occurred . Post-operative morbidity was 6.25 % for group A and 12.9 % for group B ; the two groups exhibited a similar persistent post-operative air leak rate ( 5.3 % in group A and 5.5 % in group B ) , whereas haemothorax was significantly more frequent after apical pleurectomy ( eight ( 7.4 % ) cases ) than after pleural abrasion ( one ( 0.9 % ) case ) . The mean duration of follow-up was 46 ( 24–66 ) months . Late recurrence occurred in five cases ( 4.6 % ) after apical pleurectomy , and in seven ( 6.2 % ) after mechanical pleural abrasion . Mechanical pleural abrasion by video-assisted thoracoscopic surgery is safer than apical pleurectomy in the treatment of primary spontaneous pneumothorax . No differences in late recurrence rate were observed between the two procedures BACKGROUND Although management of spontaneous pneumothorax by video-assisted thoracic surgery ( VATS ) has generally shown superior clinical results to thoracotomy , management of spontaneous pneumothorax by transaxillary minithoracotomy ( TAMT ) has also shown good clinical results . The objective of this study was to compare the clinical results of VATS and TAMT in treating spontaneous pneumothorax . METHODS Sixty-six patients , aged 13 to 81 years , with recurrent , persistent or contralateral spontaneous pneumothorax were involved in this study . Thirty-six patients were treated by VATS and 30 by TAMT . The operating time , the amount of analgesics used on the first postoperative day , the duration of the indwelling chest tube , and the number of recurrences after operation were compared . The follow-up periods of both procedures were from 6 to 24 months . RESULTS Of the 66 patients , 64 were male and 2 were female . The duration of operation , from start of skin incision to insertion of chest tube , was 91.2 + /- 36.8 minutes in VATS and 86.3 + /- 40.9 minutes in TAMT ( p = 0.6061 ) . The amount of analgesics ( keptoprofen ) used was 1.9 + /- 2.3 ampules in VATS and 2.1 + /- 2.9 ampules in TAMT ( p = 0.0883 ) . The duration of indwelling chest tube was 5.0 + /- 4.0 days in VATS and 4.3 + /- 2.1 days in TAMT ( p = 0.3707 ) . The number of recurrences after operation was 4 in VATS and none in TAMT . CONCLUSIONS There were no advantages of VATS over TAMT for management of recurrent , persistent , or contralateral spontaneous pneumothorax in regard to the operating time , the amount of analgesics used on the first postoperative day , the duration of the indwelling chest tube , and the number of postoperative recurrences in patients with apical bullae OBJECTIVE To eluci date whether thoracoscopy for surgical therapy of pneumothorax leads to a reduction of inflammatory responses in comparison with st and ard thoracotomy . DESIGN A prospect i ve r and omized study PATIENTS Eleven patients ( 9 men and 2 women ; median age , 28 years ; range , 21 - 44 years ) were treated by thoracotomy ; 10 patients ( 9 men and 1 woman ; median age , 26 years ; range , 21 - 28 years ) were managed thoracoscopically .  The plasma concentrations of the following were determined : polymorphonuclear granulocyte elastase and C-reactive protein as inflammatory parameters and prostanoids ( prostacyclin , thromboxane A2 , prostagl and in F2 alpha , prostagl and in M , and prostagl and in E2 ) as vasoactive parameters . Blood sampling was performed perioperatively and on day 3 after surgery . RESULTS The thoracoscopy group revealed a shorter hospital stay ( 5 vs 7 days ; P < .05 ) and a significantly reduced need for intravenous pain medication within 48 hours ( 1 vs 3 requirements ; P < .01 ) vs the thoracotomy group . The release of inflammatory ( C-reactive protein , P < .01 ) and vasoactive ( prostacyclin and thromboxane A2 , P < .01 ) mediators was less during thoracoscopy compared with st and ard thoracotomy . CONCLUSIONS The thoracoscopic procedure is less invasive when performing wedge resection of apical blebs . With intracavitary management being equivalent to the conventional technique , the curtailed morbidity after thoracoscopic surgery is considered to be related to the minimal trauma associated with the access to lung tissue and the reduced h and ling of lung tissue In a prospect i ve comparison , 60 patients suffering from complicated spontaneous pneumothorax were r and omly allocated to receive treatment by a video-assisted thoracoscopic surgery ( VATS ) technique or by thoracotomy .  Thirty patients underwent bullectomy and apical pleurectomy by VATS performed through three 2-cm incisions ( group V ) and 30 patients underwent a similar surgical procedure through a posterolateral thoracotomy ( group T ) . The median operating time was significantly longer in group V ( 45 versus 37.5 minutes ; p < 0.05 ) , but the postoperative analgesic requirement and hospital stay were less than those in group T. On the third postoperative day , the reductions in the forced expiratory volume in 1 second and forced vital capacity were significantly lower in group V than in group T ( p < 0.05 and p < 0.01 , respectively ) . Initial treatment of the spontaneous pneumothorax was effective in 27 patients ( 90 % ) in group V and in 29 patients ( 97 % ) in group T. There have been two late recurrences in group V and one in group T at a median follow-up of 15.1 months and 16.3 months , respectively . Within the study group , 30 consecutive patients presented with primary spontaneous pneumothorax .  In this subgroup there was no significant difference in the operating time between VATS and thoracotomy , but postoperative pain , hospital stay , and pulmonary dysfunction were all less for those undergoing VATS . All treatment failures were in the subgroup of 30 consecutive patients who presented with secondary spontaneous pneumothorax , and the hospital stay in this group was prolonged by the use of VATS . We conclude from our findings that VATS is superior to thoracotomy in the treatment of primary spontaneous pneumothorax . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND A prospect i ve , r and omized study was carried out on patients with primary spontaneous pneumothorax , with the aim of determining if video-assisted thoracoscopy is superior to axillary thoracotomy in the surgical treatment of this condition . METHODS Patients were r and omly assigned to two groups ; video-assisted thoracoscopy ( group A ; n = 46 ) and axillary thoracotomy ( group B ; n = 44 ) . All fit the established criteria for surgical indication ( relapse or persistent air leakage after pleural drainage ) . In all cases the treatment consisted of apical segmentectomy of the blebs or dystrophic complex and pleural mechanical abrasion . The study evaluated the following factors : postoperative blood loss , respiratory function ( maximum inspiratory and expiratory pressures , forced expiratory volume in the first second and forced vital capacity ) , postoperative pain ( analog visual scale ) , supplementary doses of analgesics , postoperative complications , hospital stay , and resumption of normal activity . Relapses were evaluated for the minimum period of time of two years . RESULTS No significant differences were found in any of the factors studied in either group . CONCLUSIONS Video-assisted thoracoscopy and axillary thoracotomy offer similar results in the surgical treatment of primary spontaneous pneumothorax . The rate of complication is low and the level of pain is acceptable without long-term sequelae Parietal pleurectomy is the most effective method of preventing a recurrence of spontaneous pneumothorax . Until recently , however , it has required thoracotomy which is associated with significant morbidity . The advent of video-assisted thoracoscopic surgery ( VATS ) has offered a less traumatizing method of performing parietal pleurectomy , but experience in this operation is limited . In this study we compared the operative results of our first twelve patients treated using VATS ( VATS-group ) with twelve consecutive patients operated on via thoracotomy ( T-group ) before we started using VATS .  The groups were comparable in terms of age , sex ratio and the length of preoperative pleural drainage . In the VATS-group  peroperative blood loss was markedly less , but the mean operative time was 16 min longer than in the T-group . There was practically no difference in the number of opioid dosages given postoperatively between the groups , but the hospital stay was approximately three days shorter in the VATS-group than in the T-group . Inability to work lasted two weeks longer in the T-group than in the VATS-group . In the T-group there were no recurrences of pneumothorax , but in the VATS-group  pneumothorax recurred in two patients . They were both treated using a Roeder loop to excise bullae . One patient was reoperated via thoracotomy and another was treated by pleural suction . The initial Finnish experience of VATS-pleurectomy shows that parietal pleurectomy can be performed safely with less morbidity in the treatment of recurrent spontaneous pneumothorax . However , recurrences in the VATS-group underlines the proper selection of technical methods when using this method of treatment OBJECTIVE To present our experience of video-assisted thoracoscopy in the treatment of recurrent spontaneous pneumothorax , and to compare the results with those of a historical control group treated by lateral thoracotomy . DESIGN Prospect i ve evaluation with historical controls . SETTING Teaching hospital , Italy . SUBJECTS 41 Patients with recurrent spontaneous pneumothorax , 20 of whom were treated by video-assisted thoracoscopy and 21 of whom underwent lateral thoracotomy ( historical control group ) . MAIN OUTCOME MEASURES Duration of chest drainage , length of hospital stay , amount of narcotic analgesia required , postoperative complications , and recurrence during follow up . RESULTS The mean ( range ) duration of chest drainage in the group who underwent video-assisted thoracoscopy was 5 days ( 4 - 7 ) compared with 7 days ( 4 - 13 ) in the control group ; the corresponding figures for length of hospital stay were 6 days ( 4 - 8 ) compared with 10 days ( 5 - 16 ) . 3 Patients ( 15 % ) in the thoracoscopy group required parenteral narcotic analgesia compared with 14 ( 66 % ) in the control group , and 2 ( 10 % ) developed minor complications compared with 5 ( 24 % ) . The mean length of follow up was 9 months ( range 1 - 18 ) compared with 26 months ( 19 -  
    Output:
    
Results Access remained the principal determinant of recurrence rates after surgery .
ConclusionS urgical access remains the most important factor that influences outcome after surgery for recurrent pneumothoraces .