Thoracoscopic one window plus puncture method for spontaneous pneumothorax.
OBJECTIVE
The aim of this article is to present a new method for treating spontaneous pneumothorax, the one window plus puncture method (1WP) in which a thin endoscope is used.


METHODS
With the patient in the lateral position and under one-lung ventilation, a one-window working port was created on the ventral side. An introducer was inserted on the dorsal side, and the operation to treat spontaneous pneumothorax was performed under observation with a thin endoscope, that was 2 mm to 3 mm in diameter.


RESULTS
This study enrolled 540 patients, in whom thoracoscopic surgery was performed in order to treat spontaneous pneumothorax during the period from 1995 to 2004. The cases were divided into two groups: the first group comprised 324 cases (TWM group) in which surgery was performed by the two windows method (TWM), and the second group comprised 216 cases (1WP group) in which surgery was performed by the one window plus puncture method (1WP) using a thin endoscope. After surgery the two groups were compared. The TWM group consisted of 282 males and 42 females, and the patients' mean age was 32+/-14.5 years (range: 15 to 76 years). The 1WP group consisted of 202 males and 14 females, and the patients' mean age was 21.6+/-6.1 years (range: 15 to 48 years). The mean interval between hospital admission and surgery was 1.5+/-2.8 days in the TWM group and 0.9+/-1.5 days in the in the 1WP group. The mean interval between surgery and hospital discharge was 3.3+/-2.5 days in the TWM group and 2.3+/-0.7 days in the 1WP group. There was a postoperative recurrence in 13 (4%) of the cases in the TWM group, and reoperation was performed in 8 of them; and there was a recurrence in 7 (3.2%) of the cases in the 1WP group, and reoperation was performed in all of them. Thoracoscopic surgery using the thin endoscope was esthetically superior, surgical invasion was minor, and the patients were able to return to their daily lives sooner.


CONCLUSIONS
A thoracoscopic surgery performed aggressively to treat spontaneous pneumothorax made it possible for the patients to return to their daily lives sooner. As thoracoscopic surgery by the 1WP method eliminates the access site on the dorsal side, used in the TWM, and utilizes only a 2 mm to 3 mm puncture, it is a more esthetic procedure, similar in terms of appearance to inserting a pleural drain without performing surgery.
Iwazaki
M
M
Division of General Thoracic Surgery, Department of Surgery, Tokai University School of Medicine, Isehara Kanagawa, Japan. iwasaki@is.icc.u-tokai.ac.jp
Inoue
H
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000628:therapy*; D011677:Punctures / Q000379:methods*; D013906:Thoracoscopy / Q000379:methods*; D055815:Young Adult