Thoracoscopic ipsilateral approach to contralateral bullous lesion in patients with bilateral spontaneous pneumothorax

Wu, Yi‐Cheng; Chu, Yen; Liu, Yun-Hen; Yeh, Chi-Ju; Chen, Tzu-Ping; Liu, Huiping

doi:10.1016/s0003-4975(03)00965-2

Cited by 29 publications

(21 citation statements)

References 6 publications

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“…The procedure was attempted in six patients and was successful and uneventful in four. The other two underwent bilateral VATS due to pleural adhesions [129]. However, a study of six patients represents too small a sample to draw any conclusions.…”

Section: Surgical Approaches To Both Lungsmentioning

confidence: 97%

Management of spontaneous pneumothorax: state of the art

Jm¹,

Rami–Porta²,

Noppen³

et al. 2006

European Respiratory Journal

190

141

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Spontaneous pneumothorax remains a significant health problem. However, with time, there have been improvements in pathogenesis, diagnostic procedures and both medical and surgical approaches to treatment.Owing to better imaging techniques, it is now clear that there is almost no normal visceral pleura in the case of spontaneous pneumothorax, and that blebs and bullae are not always the cause of pneumothorax. In first episodes of primary spontaneous pneumothorax, observation and simple aspiration are established first-line therapies, as proven by randomised controlled trials. Aspiration should be better promoted in daily medical practice. In the case of recurrent or persistent pneumothorax, simple talc poudrage under thoracoscopy has been shown to be safe, cost-effective and no more painful than a conservative treatment using a chest tube. There are also new experimental data showing that talc poudrage, as used in Europe, does not lead to serious side-effects and is currently the best available pleural sclerosing agent.Alternatively, surgical techniques have considerably improved, and are now less invasive, especially due to the development of video-assisted thoracoscopic surgery. Studies suggest that video-assisted thoracoscopic surgery may be more cost-effective than chest tube drainage in spontaneous pneumothorax requiring chest tube drainage, although it is more expensive than simple thoracoscopy and requires general anaesthesia, double-lumen tube intubation and ventilation.Recommendations are made regarding the treatment of pneumothorax. In secondary or complicated primary pneumothorax, i.e. recurrent or persistent pneumothorax, some diffuse treatment of the visceral pleura should be offered, either by talc poudrage under thoracoscopy or by video-assisted thoracoscopic surgery. Moreover, all of these new techniques should be better standardised to permit comparison in randomised controlled studies.

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Section: Surgical Approaches To Both Lungsmentioning

confidence: 97%

Management of spontaneous pneumothorax: state of the art

Jm¹,

Rami–Porta²,

Noppen³

et al. 2006

European Respiratory Journal

190

141

View full text Add to dashboard Cite

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“…More recently, Cho et al ( 14 ) introduced a method of apicoposterior transmediastinal access (between the esophagus and vertebrae) to perform simultaneous bilateral VATS bullectomy. In the present study, the procedures for bilateral bullectomy were almost the same as those described by Wu et al., ( 13 ) although the incision in the anterior mediastinal pleura was smaller, and a longer, longitudinal incision was made in the mediastinum, under the sternum. That incision was 8- to 10-cm in length, which is long enough to allow exploration of the lung on the contralateral side.…”

Section: Discussionmentioning

confidence: 67%

“…( 11 , 12 ) Wu et al ( 13 ) were the first to report the successful use of bilateral bullectomy through unilateral VATS, in four patients. More recently, Cho et al ( 14 ) introduced a method of apicoposterior transmediastinal access (between the esophagus and vertebrae) to perform simultaneous bilateral VATS bullectomy.…”

Section: Discussionmentioning

confidence: 99%

Bulectomia bilateral por cirurgia torácica vídeo-assistida uniportal combinada com acesso contralateral ao mediastino anterior

et al. 2013

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OBJECTIVE: Video-assisted thoracoscopic surgery (VATS) has been a surgical intervention of choice for the treatment of spontaneous pneumothorax (SP) with lung bulla. Our objective was to introduce a uniportal VATS approach for simultaneous bilateral bullectomy and to evaluate its therapeutic efficacy. METHODS: Between May of 2011 and January of 2012, five patients underwent bilateral bullectomy conducted using this approach. All of the patients presented with bilateral SP. Preoperative HRCT revealed that all of the patients had bilateral apical bullae. We reviewed the surgical indications, surgical procedures, and outcomes. RESULTS: All of the patients were successfully submitted to this approach for bilateral bullectomy, and there were no intraoperative complications. The median time to chest tube removal was 4.2 days, and the median length of the postoperative hospital stay was 5.2 days. The median postoperative follow-up period was 11.2 months. One patient experienced recurrence of left SP three weeks after the surgery and underwent pleural abrasion. CONCLUSIONS: Bilateral bullectomy through uniportal VATS combined with contralateral access to the anterior mediastinum is technically reliable and provides favorable surgical outcomes for patients with bilateral SP who develop bilateral apical bullae. However, among other requirements, this surgical procedure demands that surgeons be experienced in VATS and that the appropriate thoracoscopic instruments are available.

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“…Wu et al [10] advocated the concept of unilateral transmediastinal VATS for bilateral apical bullous lesions; however, the reported technique should be performed under a strict protocol, for example, right-sided approach. Because blood clot and pleural adhesion were presented at left hemithorax, the authors believe that bilateral VATS should be a safe method for the present case.…”

Section: Discussionmentioning

confidence: 99%