Uniportal Thoracoscopic Surgery for Primary Spontaneous Pneumothorax: Use of a Spinal Needle to Replace a Grasper
Dae Hyun Kim1, Hyo Chul Youn2, Sang Ho Cho1, Young Tae Kwak1.
1Kyung Hee University Hospital at Gangdong, Seoul, Korea, Republic of, 2Kyung Hee University Hospital, Seoul, Korea, Republic of.
Thoracoscopic wedge resection using three ports is a technique of choice for the primary spontaneous pneumothorax. A few publications describing the uniportal thoracoscopic surgery an alternative to conventional thoracoscopic surgery have been reported. We herein introduce uniportal thoracoscopic technique using a spinal needle to replace a grasper.METHODS:
Between March and November 2011, 20 patients were enrolled. Only one incision (2.0 cm long) is placed in the 5th intercostal space in the mid-axillary line. A 5 mm 30° thoracoscope and routinely used without guidance of a trocar. A 5mm grasper or Chitwood clamp was used to grasp the bulla or bleb. A 20 gauge spinal needle was bended about 90° and inserted to the pleural cavity through 3rd intercostal space in the mid-axillary line. The bulla or bleb was hooked by the inserted spinal needle and a 5mm grasper or Chitwood clamp was taken out of the pleural cavity. The wedge resection was performed with roticulating stapler (endo-GIA, Covidien). The coverage of the stapled line with fibrin glue and Neoveil® sheet was performed additionally. The pleural abrasion or chemical pleurodesis was not routinely performed. A 24 French chest tube was positioned through the single incision.RESULTS:
Patients included 16 men and 4 women with the mean age of 23 years (range 15~49). The mean operative time was 34 minutes (range 20~60). Neither mortality nor major morbidity was observed. The median chest drain duration and hospital stay were 2 days (range 1~3) and 3 days (range 2~4), respectively. No recurrence of spontaneous pneumothorax was observed until 10 December, 2011.
Only 5 mm scope and stapler is inserted through a 2.0 cm incision during stapling in the uniportal thoracoscopic technique by use of a spinal needle to replace grasper. We suggest that this technique is simple and easy to perform and applicable to primary spontaneous pneumothorax.
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