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Single incision VATS bullectomy with suture-lift method in primary spontaneous pneumothorax
Chun Sung Byun, MD, Jung Joo Hwang, MD, Ph.D, Jin Ho Choi, MD.
Eulji University Hospital, Daejeon, Korea, Republic of.

OBJECTIVE: VATS using the baseball-diamond concept is currently the technique of choice for three port VATS bullectomy of primary spontaneous pneumothorax. However, the procedure has been shown to have neurological paresthesia and pain related to the port sites. Single incision VATS(SITS) has been proposed as an alternative to three port VATS for anticipating lower incidence of neurological complications and less wound. Also, SITS needs specific single port instrument for ergonomic technique application. But, without SITS equipment, we had performed SITS bullectomy using suture-lift method with the conventional VATS instrument.
METHODS: We evaluate our initial experience of suture-lift SITS bullectomy(n=12), with randomly assigned three port VATS bullectomy(n=12) provide a comparison of post-operative result and pain in same period.
RESULTS: All pneumothorax was primary spontaneously occured and diagnosed by chest X-ray and chest CT. All surgical procedure during three port VATS was performed adequately in suture-lift SITS such as endo-stapling, mechanical pleurodesis, air leak test and cover a polyglycolic acid sheet with fibrin glue. There was no difference between the groups in terms of age, resected tissue number, operation time, drainage time and in-hospital stay. However, a difference between post-operative pain scores was noted. The suture-lift SITS group had a lower median score of 2.6(visual analogue range 1~10) while the three-port technique reported 4.2(P<0.05, Paired T-test). During one month follow-up for single incision and three-port VATS, there was no patient had a pneumothorax recurrence in both group.
CONCLUSIONS: Suture-lift SITS bullectomy appears to easily applicable, safe and efficient in treating primary spontaneous pneumothorax in hospital did not prepare single port equipment. Moreover, post-operative pain incidence was lower than three-port VATS.


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