New electroablation technique following the first-line stapling method for thoracoscopic treatment of primary spontaneous pneumothorax.
OBJECTIVE
A new tip for the electroablation of pneumocysts was examined clinically as a second-line method for stapled resection of pneumocysts during video-assisted thoracoscopic surgery (VATS).


METHODS
A trial to assess feasibility.


METHODS
National referral hospitals.


METHODS
One hundred seven patients were studied, of whom 99 patients were eligible for the study (85 men and 14 women; age range, 15 to 69 years; median age, 23 years), who had undergone VATS for primary spontaneous pneumothorax between July 1996 and June 1998. Apical pneumocysts were resected employing staplers, and residual pneumocysts, if present, were electroablated employing a new tip for the electrosurgery unit (ball shape, 8 mm in diameter, and made of stainless steel).


RESULTS
Thirty-three patients (33%) underwent electroablation only for small (< 2 cm in diameter) pneumocysts (group S), and 11 patients (11%) underwent electroablation for large (>/= 2 cm in diameter) pneumocysts (group L). The remaining 55 patients (56%) did not undergo electroablation because there were no residual pneumocysts (group N). There were no complications during surgery. The duration of the operation was significantly shorter (about 20 min on average) for group N, but there was no significant difference in the amount of blood loss, the number of applied staples, the duration of drainage, and the duration of hospital stay. Group S achieved a 100% relapse-free rate (33 of 33 patients), group L achieved a 64% relapse-free rate (7 of 11 patients), and group N achieved an 89% relapse-free rate (49 of 55 patients) [group S vs group N, p = 0.08; group L vs group N, p = 0.001; and group S vs group L, p = 0.002].


CONCLUSIONS
Electroablation with the M-tip is feasible as a second-line method for the treatment of small pneumocysts following the stapling technique during VATS.
Sawabata
Noriyoshi
N
Thoracic Surgery Study Group of Osaka University, Osaka, Japan. nori@toneyama.hosp.go.jp
Ikeda
Masahito
M
Matsumura
Akihide
A
Maeda
Hajime
H
Miyoshi
Shinichiro
S
Matsuda
Hikaru
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D004564:Electrocoagulation / Q000295:instrumentation*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000601:surgery*; D011656:Pulmonary Emphysema / Q000601:surgery*; D013528:Surgical Staplers; D020775:Thoracic Surgery, Video-Assisted / Q000295:instrumentation*