Spontaneous pneumothorax in adolescents is often bilateral, because bullae and blebs are frequently present in both lungs.
Operations for bilateral pneumothorax have been usually performed through open thoracotomy, either simultaneously on both lungs or in two stages. However, an one-stage operation through bilateral axillary or posterolateral incisions may be alternative to procedures. Nowadays, for cosmetic reasons, we hesitate to perform thoracotomy through to median sternotomy or transsternal bilateral thoracotomy in adolescents. Therefore, we used one-stage bilateral thoracoscopic surgery to treat three young patients with bilateral spontaneous pneumothorax. The patients were placed in the supine position and given general anesthesia through a double-lumen tube. Thoracoscopic procedures upon the lungs were carried out first on one side and then on the other side of the thorax. The first incision was placed in the seventh intercostal space in the anterior axillary line. Two trocars were inserted through the third and fifth intercostal spaces. Circumscribed pulmonary leaks or bullae were treated with pulmonary wedge resection with ENDO-GIA or ligation of bullae with ENDO-LOOP. During this procedure there were no particular problems with hemodynamic stability or arterial blood gas levels. The average duration of hospitalization after the procedures was 10 days. We used this one-stage thoracoscopic surgery to treat three young patients with bilateral spontaneous pneumothorax in the supine position and encountered no great difficulty.
We consider that this approach is another alternative method for bilateral pneumothorax in adolescents.