Introduction to minimally invasive surgery for pneumothorax: current frontiers

Pneumothorax is a clinically important and common thoracic disorder that can occur not only in otherwise healthy individuals but also in patients with underlying lung disease. The effectiveness of surgical treatment for primary spontaneous pneumothorax (PSP) has already been well established (1), and over the past several decades, significant advances in surgical techniques (2-4) and perioperative management (5) have been achieved. These developments have contributed to improved clinical outcomes, reduced morbidity, and an expanded range of treatment options for recurrent and complicated cases.

Video-assisted thoracoscopic surgery (VATS) has been widely adopted since the 1990s (2), and more recently, the introduction of the uniportal approach (uniportal VATS; uVATS) has brought remarkable progress in surgical minimally invasive approaches (6). Recent reports have documented extremely low recurrence rates of 1.7–2.8% (7), establishing uVATS, together with favorable perioperative outcomes, at the forefront of minimally invasive surgical treatment.

Moreover, studies have shown that compared with multiportal VATS (mVATS), uVATS is associated with significantly less postoperative pain in the early period, without differences in recurrence or complication rates (8). VATS has also been demonstrated to shorten hospitalization compared with thoracotomy (9). From a cost-effectiveness perspective, VATS has been reported to be more advantageous than pleural drainage (10).

Technological innovation extends beyond surgical techniques to perioperative management. The introduction of digital drainage systems has enabled more accurate assessment of air leak cessation compared with conventional analog systems, with the potential to avoid unnecessary clamping procedures (5). Particularly noteworthy is the adoption of nonintubated VATS (11), with growing evidence emerging primarily from Asia. This approach may even redefine the standard of care in thoracic surgery.

This special series was conceived to provide a comprehensive overview of the current state of pneumothorax management. Internationally recognized experts have contributed as authors, discussing the latest evidence, technical innovations, and unresolved challenges. We hope that this series will serve as a valuable resource for thoracic surgeons in their daily practice, while also laying the groundwork for future innovation and international collaboration. Through the dissemination of knowledge and the refinement of surgical and perioperative strategies, we aspire to advance safer, more effective, and patient-centered care for individuals with pneumothorax.

Acknowledgments

None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Journal of Visualized Surgery for the series “Minimally Invasive Surgery for Pneumothorax: Current Frontiers”. The article did not undergo external peer review.

Funding: None.

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://jovs.amegroups.com/article/view/10.21037/jovs-25-41/coif). The series “Minimally Invasive Surgery for Pneumothorax: Current Frontiers” was commissioned by the editorial office without any funding or sponsorship. N.K. served as the unpaid Guest Editor of the series and serves as an unpaid editorial board member of Journal of Visualized Surgery from May 2025 to April 2027. The author has no other conflicts of interest to declare.

Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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Naoya Kitamura