“…The bleeding usually originates from the ruptured aberrant blood vessels on the surface of bullae/blebs, which adhered to the chest wall (Tsukioka et al, 1989). Earlier reports suggest that SHP can be treated with chest tube insertion (de Perrot et al, 2000), and surgical intervention is reserved for patients with massive bleeding and hemodynamic instability, persistent bleeding for more than 24 h or retained blood clots refractory to tube drainage (Hart et al, 2002). Since VATS has gradually replaced open thoracotomy as the standard surgical approach for patients with PSP, its minimal invasiveness, excellent safety, and effectiveness makes it the primary treatment for SHP (Miyazawa et al, 2002;Luh and Tsao, 2007).…”