Video-assisted bullectomy using needlescopic instruments for spontaneous pneumothorax

Abstract

Patients with spontaneous pneumothorax require immediate insertion of a chest drain to evacuate the intrathoracic air. During video-assisted bullectomy, we made use of an existing chest drain hole to insert a thoracoscope or an endoscopic linear stapler. Video-assisted bullectomy was performed through three ports-two 2-mm ports and the existing chest drain hole. Therefore, no new skin incisions were required for the insertion of the 2-mm ports. A chest drain was again inserted via the existing chest drain hole after bullectomy. This procedure was used on 8 of 10 patients with spontaneous pneumothorax. There were no postoperative complications or recurrences. Thoracoscopic bullectomy using needlescopic instruments is technically feasible, safe, and effective. Currently, the procedure is indicated only for simple cases and not for the lysis of adhesions.

Management of spontaneous pneumothorax: state of the art

“…The use of needlescopic instruments (2 mm in diameter) has been found to reduce post-operative wound pain [123] and residual neuralgia [124]. The presence of dense pleural adhesions is an indication for conversion to standard VATS [125]. Although published experience is scarce, needle thoracoscopy seems to be as effective as conventional VATS when there are bullae of ,2 cm and few pleural adhesions.…”

Retrospective Analysis Of Treatment Options In First Recurrences Of Primary Spontaneous Pneumothorax In Young Adults

“…Advances in endoscopic instruments and improvement of the laparoscopic skills even in the field of thoracic surgery, the use of VATS has increased throughout the world and thoracoscopic bullectomy for SP have been well-accepted (13). We performed successful VATS procedures and pleural abration in 15 patients of SP.…”

A comparative study of two- versus one-lung ventilation for needlescopic bleb resection

“…For thoracic procedures, it has been used for diagnostic thoracoscopy [14], laser ablation or thoracic sympathectomy for palmar hyperhidrosis [15]. Recently, this technique has been used for lung biopsy procedures for diffuse pulmonary disease [16] and bullectomy for patients with a spontaneous pneumothorax [3,17]. Recently, we reported the first needlescopic resection of a small pulmonary nodule [4].…”

“…As thoracoscopic surgical techniques continue to improve, the size of the thoracoscope has gradually decreased. Recently, a 2-mm thoracoscope (a needlescope) and accompanying instruments have been introduced for bullectomy [3]. Since September 2004, we have performed needlescope surgery in all patients that required a lung biopsy [4].…”