Our operative technique for spontaneous pneumothorax via thoracoscopy ; coagulation by electric cautery and continuous suture of bleb or bulla

Abstract

Since November 1992, we have performed 12 thoracoscopic operations for spontaneous pneumothorax, 10 primary and 2 secondary (tuberculosis and pulmonary fibrosis). In this report, we introduce our operative technique for the treatment of blebs or bullae : coagulation by electric cautery and double continuous sutures. The mean operation time was 80 minutes and the mean period of chest drainage after operation was 2.1 days (max. 3 days). The postoperative course was uneventful, and no recurrence has been experienced to date. An endoscopic stapler is generally used in the thoracoscopic treatment for spontaneous pneumothorax with resection of the lung tissue containing the bleb or bulla. This useful instrument can remove the lesion completely and shorten operation time. However, the specimen cut by stapler tends to be larger than necessary. Moreover, the size and the location of specimens which can be resected by staplers is limited, and the staples can be seen on chest X-ray films forever. We conclude that our operative technique, i. e., coagulation by electric cautery and double continuous suture, is beneficial because this technique is free from such demerits and can be performed at lower cost than resection by endoscopic stapler.