A new thoracoscopic looping of blebs in spontaneous pneumothorax

two puncture technique

Abstract

Conventional thoracoscopic ablation of blebs required three or five stab wounds. Forty patients with spontaneous pneumothorax were treated with a new procedure, called “two puncture technique”, using a PDS II-endoloop. An incision was made in the mid-axillary line in the 5th intercostal space. A trocar was inserted, and a semiflexible thoracoscope was passed through it. The other trocar was placed in the mid-axillary line in the 3rd intercostal space. The identified bleb was grasped with an atraumatic grasper through this trocar. A PDS II-endoloop was placed around the grasper and guided to the bleb through the same trocar, and finally placed around the bleb and secured. This procedure was repeated for double ligature of the bleb.
Thoracography (TG), chest CT and thoracoscopy (TS) must be performed before operation in our center. To study the indications for this technique, we recorded the size and number of blebs. To study the extent of surgical damage and the recurrence rate after this approach, we measured eight variables : operation time, duration of fever (more than 37°C), highest postoperative temperature, volume of blood loss at operation, total volume of drainage for two days after operation, white blood cell counts on the 1st postoperative day, CRP on the 3rd POD and rate of postoperative recurrence. It was possible to use the technique for blebs up to 5 cm in diameter and in segments 1, 2, 3, 6, and 8. The average time of operation was 59.6 (SD ± 33. 7) minutes. The average period of postoperative fever was 3.8 (SD ± 1.3) days. The avarage value of the highest temperature was 38.0 (SD ± 0.4). The bleeding during operation was slight. The average volume of drainage after operation was 57 (SD 70) ml. The average WBC count was 9870 (SD ± 1550) /mm². The average value of CRP was 11.5 (SD ± 7.1) mg/ dl. There has been no recurrence of blebs in any of 40 patients.