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Ann Thorac Surg 1993;56:691-693
© 1993 The Society of Thoracic Surgeons

Articles

Thoracoscopic stapled bullectomy supported by suturing

Akira Yamaguchi, MD*, Mayumi Shinonaga, MD, Shoh Tatebe, MD, Takahiro Souma, MD, Masanori Tsuchida, MD, Akira Saito, MD

Department of Thoracic Surgery, National Nishi-Niigata Hospital, Niigata, Japan

* Address reprint requests to Dr Yamaguchi, Department of Thoracic Surgery, National Nishi-Niigata Hospital, 1-14-1, Masago, Niigata-shi, Niigata, 950-21 Japan.

In 1985, a thoracoscopic technique for closing bullae with hemostatic clips was developed. However, the method was limited, and therefore clinical application was small. A linear endoscopic stapler (Endo-GIA) was developed in 1990. The advent of the Endo-GIA nearly made thoracoscopic treatment of spontaneous pneumothorax practicable, and ended the use of clipping. In addition, a new operative technique was developed, the 3-cm minithorac bullectomy for the treatment of spontaneous pneumothorax. This technique has now become obsolete. The current method is that of a thoracoscopic stapled bullectomy using the Endo-GIA, supported by suturing. The recurrence rate was 2.7% ([equation]) using this method. The one recurrence occurred in a case where no bullae were observed during the operation. Our findings suggest that thoracoscopic stapled bullectomy supported by suturing is a practicable treatment of spontaneous pneumothorax. An economical use of the endoscopic stapler and complementary suturing may be less expensive than using a laser. Pleurodesis should be performed in the patients in whom no distinct bullae are discovered thoracoscopically.




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