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OBJECTIVE:
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 5^th 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 3^rd 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.
CONCLUSIONS:
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.