minimally invasive techniques Thoracoscopic Management of Spontaneous Pneumothorax* W Scott Melvin, M.D.; Mark J Krasna, M.D.; and joseph S. McLaughlin, M.D.
(Chest 1992; 102:1875-76)
Modern thoracoscopy currently allows minimally invasive access to the chest cavity with the ability to assess and treat a wide variety of intrathoracic lesions. Spontaneous pneumothorax is a common ailment occurring in 9 patients per 1,000 persons per year. 1 Pneumothorax is usually treated with tube decompression, often followed by chemical pleurodesis. Recurrence or persistent air leak requires formal surgical therapy. Traditionally, this has involved thoracotomy with resection of visible parenchymal blebs For editorial comment see page 1644 and mechanical pleurodesis or pleurectomy. While formal thoracotomy is associated with a low recurrence rate, the morbidity and disability remain formidable. Thoracoscopy allows full visualization of the lung and pleura and, when combined with a resection of blebs and pleurodesis or pleurectomy, results in a low recurrence rate, minimal patient discomfort, and rapid recovery. We will describe six patients treated for spontaneous pneumothorax and discuss current thoracoscopic treatment options. MATERIALS AND METHODS
IUtients Case I: A 22-year-old black woman was admitted for her first spontaneous pneumothorax. Initially treated with tube decompression, she continued to have an air leak for 7 days. Thoracospy was performed, and staple resection of what appeared to be a mllapsed bleb was performed. Pleurodesis with electrocautery was also done. Postoperatively, she developed another air leak and was returned to the operating room on postoperative day 10 for a limited thoramtomy and apical pleurectomy. Pathologic examination of the lung tissue was consistent with interstitial pulmonary fibrosis. She did well and was discharged 4 days later. Case 2: A 24-year-old black woman presented with her semnd spontaneous pneumothorax. Initial tube decompression reinflated the lung. She underwent thoracoscopy with apical blebectomy using an endoscopic stapler. Chemical pleurodesis was performed with doxycycline, and a partial pleurectomy of the apex was done. Postoperative recovery was uneventful, and she was discharged on *From the Department of Surgery (Dr. Melvin) and the Division of Thoracic and Cardiovascular Surgery (Drs. Krasna and McLaughlin), University of Maryland, Baltimore. Reprint requests: Dr. Krasna, 22 South Greene Street, Baltirrwre 21201
postoperative day 2. (This woman has a brother who undt•rwt•nt thoracotomy and pleurectomy I year previously. He was discharged on postoperative day 7). Case 3: An 18-year-old white man with a history of asthma presented with a fourth spontaneous pneumothorax on one sidt·. He previously had two pneumothoraces on the other sidt>. He underwent a thorascopic resection of multiple blebs using the endoscopic linear stapling device. Chemical and mechanical pleurodesis was performed with the use of a "home-made" endoscopic Kittner dissector and doxycycline. He was discharged on postoperative day 3. Case 4: A 20-year-old white man presented with his semnd rightsided pneumothorax. Previously he had developed a contralateral pneumothorax, which was treated w~th tube decompression. Thora
(Chest 1992; 102:1875-76)
Modern thoracoscopy currently allows minimally invasive access to the chest cavity with the ability to assess and treat a wide variety of intrathoracic lesions. Spontaneous pneumothorax is a common ailment occurring in 9 patients per 1,000 persons per year. 1 Pneumothorax is usually treated with tube decompression, often followed by chemical pleurodesis. Recurrence or persistent air leak requires formal surgical therapy. Traditionally, this has involved thoracotomy with resection of visible parenchymal blebs For editorial comment see page 1644 and mechanical pleurodesis or pleurectomy. While formal thoracotomy is associated with a low recurrence rate, the morbidity and disability remain formidable. Thoracoscopy allows full visualization of the lung and pleura and, when combined with a resection of blebs and pleurodesis or pleurectomy, results in a low recurrence rate, minimal patient discomfort, and rapid recovery. We will describe six patients treated for spontaneous pneumothorax and discuss current thoracoscopic treatment options. MATERIALS AND METHODS
IUtients Case I: A 22-year-old black woman was admitted for her first spontaneous pneumothorax. Initially treated with tube decompression, she continued to have an air leak for 7 days. Thoracospy was performed, and staple resection of what appeared to be a mllapsed bleb was performed. Pleurodesis with electrocautery was also done. Postoperatively, she developed another air leak and was returned to the operating room on postoperative day 10 for a limited thoramtomy and apical pleurectomy. Pathologic examination of the lung tissue was consistent with interstitial pulmonary fibrosis. She did well and was discharged 4 days later. Case 2: A 24-year-old black woman presented with her semnd spontaneous pneumothorax. Initial tube decompression reinflated the lung. She underwent thoracoscopy with apical blebectomy using an endoscopic stapler. Chemical pleurodesis was performed with doxycycline, and a partial pleurectomy of the apex was done. Postoperative recovery was uneventful, and she was discharged on *From the Department of Surgery (Dr. Melvin) and the Division of Thoracic and Cardiovascular Surgery (Drs. Krasna and McLaughlin), University of Maryland, Baltimore. Reprint requests: Dr. Krasna, 22 South Greene Street, Baltirrwre 21201
postoperative day 2. (This woman has a brother who undt•rwt•nt thoracotomy and pleurectomy I year previously. He was discharged on postoperative day 7). Case 3: An 18-year-old white man with a history of asthma presented with a fourth spontaneous pneumothorax on one sidt·. He previously had two pneumothoraces on the other sidt>. He underwent a thorascopic resection of multiple blebs using the endoscopic linear stapling device. Chemical and mechanical pleurodesis was performed with the use of a "home-made" endoscopic Kittner dissector and doxycycline. He was discharged on postoperative day 3. Case 4: A 20-year-old white man presented with his semnd rightsided pneumothorax. Previously he had developed a contralateral pneumothorax, which was treated w~th tube decompression. Thora
