A systematic review and meta-analysis of video-assisted thoracoscopic surgery treating spontaneous pneumothorax

BACKGROUND: With the adoption of high-tech thoracoscopic surgical instruments, video-assisted thoracoscopic surgery (VATS) has gradually replaced traditional thoracotomy and is used in the clinical treatment of spontaneous pneumothorax. METHODS: The composite logic retrieval and Boolean logic retrieval methods were adopted for this meta-analysis. Databases such as PubMed, Medline, Cochrane Library, CNKI, Wanfang, VIP, and Google Scholar were searched using the combination of search terms “Video-assisted thoracoscopic surgery”, “spontaneous pneumothorax”, and “thoracotomy”. Literatures which used video-assisted thoracoscopic surgery for spontaneous pneumothorax as the experimental group were screened. The software RevMan 5.3 provided by the Cochrane system was employed for meta-analysis. RESULTS: A total of 12 studies were included. After the meta-analysis, heterogeneity testing of the operation time in 8 studies showed that Tau(2) =29.99, Chi(2) =16.99, degrees of freedom (df) =7, I(2)=59%>50%, and the operation time of participants in the experimental group was considerably inferior to that of control group. The mean difference (MD) was −31.02, 95% confidence interval (95% CI: −36.07 to −25.97), Z=12.03, P<0.0001. The heterogeneity test of the length of hospital stay in 9 studies showed that Tau(2) =4.41, Chi(2) =122.58, df =8, I(2)=59%>50%, P<0.01, and the length of hospital stay of participants in the experimental group was remarkably shorter than that of the control group. The MD was −7.29, 95% CI: (−8.76 to −5.82), Z=9.74, and P<0.01. The heterogeneity test of the bleeding volume in 6 studies showed that Tau(2) =191.74, Chi(2) =27.65, df =5, I(2)=82%>50%, P<0.01, and the bleeding volume of participants in the experimental group was remarkably lower in contrast to that of the control group. The MD was −65.48, 95% CI: (−77.84 to −53.13), Z=10.39, and P<0.01. The heterogeneity test of the chest tube removal time in 7 studies showed that Tau(2) =0.29, Chi(2) =28.27, df =6, I(2)=79%>50%, P<0.05, and the chest tube removal time of participants in the experimental group was substantially lower in contrast to that of the control group. The MD was −3.10, 95% CI: (−3.56 to −2.64), Z=13.30, P<0.01. DISCUSSION: This meta-analysis confirmed that VATS for spontaneous pneumothorax is better than other surgical methods.