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This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Ronald M. Becker Kwang Ho Kim Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Becker, R. M. Articles by Kim, J. T. Search for Related Content PubMed PubMed Citation Articles by Becker, R. M. Articles by Kim, J. T.

Ann Thorac Surg 1996;62:1887
© 1996 The Society of Thoracic Surgeons

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Correspondence

Transaxillary Minithoracotomy for Spontaneous Pneumothorax

Po Box 3012, Chico, Ca 95927

To the Editor:

I would like to comment on the recent article by Kim and associates [1]. Since I learned the transaxillary minithoracotomy (TAMT) technique from Dr Munro [2], I have had extensive experience with it. Although I have not maintained statistics, I would imagine that I have used TAMT in well over 100 patients for treatment of pneumothorax. In my experience it has been uniformly successful in terms of exposure, patient comfort, and relief of the problem without recurrences. As noted by Kim and associates it requires only a short and cosmetically acceptable incision, and because the incision is in the direction of the serratus anterior muscle fibers, these fibers can be easily separated without actually cutting them. This makes for a less painful incision.

I disagree with Kim and associates' comments with regard to exposure. Major blebs and bullae are generally situated in the apical portion of the upper lobes or superior segment of the lower lobes. These are certainly easily accessible via TAMT; however, in my experience any portion of any lobe is also easily accessed via TAMT. I generally perform an apicoposterior pleurectomy rather than simple mechanical abrasion, and this is also easily accomplished via TAMT. The entire operation should take less than 45 minutes.

I have extensive experience with video-assisted thoracoscopic approaches for other conditions, but I believe TAMT is superior to video-assisted thoracoscopy by any measure for the treatment of spontaneous pneumothorax, and I compliment Kim and colleagues for their contribution to this subject.

References

1. Kim KH, Kim HK, Han JY, et al. Transaxillary minithoracotomy versus video-assisted thoracic surgery for spontaneous pneumothorax. Ann Thorac Surg 1996;61:1510–2.[Abstract/Free Full Text]
2. Becker RM, Munro DD. Transaxillary minithoracotomy: the optimal approach for certain pulmonary and mediastinal lesions. Ann Thorac Surg 1976;22:254–9.[Abstract/Free Full Text]

Reply

Department of Thoracic Cardiovascular Surgery, Inha University Hospital, 7-206 Shinheudong 3-ka, Choonggu, Inchon 400-103, South Korea

To the Editor:

Our colleagues and we appreciate the comments of Dr Becker. We have recognized his contributions to transaxillary minithoracotomy (TAMT) for a long time. As he comments, we also think TAMT is simple and excellent for managing spontaneous pneumothorax. However, we think there are portions of the lung that are difficult to expose, such as basal segments of the lower lobe near the diaphragm, through a small opening in the second or third intercostal space made by TAMT. It is also inconvenient to do some surgical procedures for managing lesions in the lower lobe through a TAMT, although we can finish them. We think it is lucky for surgeons that most of the bullae and blebs are situated in the upper lobe. We agree that an apicoposterior pleurectomy could be done through a TAMT. But simple mechanical pleural abrasion is enough for preventing recurrence of pneumothorax. We usually do not perform an apical pleurectomy for managing simple pneumothorax through a TAMT.

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Ronald M. Becker Kwang Ho Kim Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Becker, R. M. Articles by Kim, J. T. Search for Related Content PubMed PubMed Citation Articles by Becker, R. M. Articles by Kim, J. T.