title: Bilateral bullectomy through uniportal video-assisted thoracoscopic surgery combined with contralateral access to the anterior mediastinum.
abstract: OBJECTIVE
  Video-assisted thoracoscopic surgery (VATS) has been a surgical intervention of choice for the treatment of spontaneous pneumothorax (SP) with lung bulla. Our objective was to introduce a uniportal VATS approach for simultaneous bilateral bullectomy and to evaluate its therapeutic efficacy.
  
  
  METHODS
  Between May of 2011 and January of 2012, five patients underwent bilateral bullectomy conducted using this approach. All of the patients presented with bilateral SP. Preoperative HRCT revealed that all of the patients had bilateral apical bullae. We reviewed the surgical indications, surgical procedures, and outcomes.
  
  
  RESULTS
  All of the patients were successfully submitted to this approach for bilateral bullectomy, and there were no intraoperative complications. The median time to chest tube removal was 4.2 days, and the median length of the postoperative hospital stay was 5.2 days. The median postoperative follow-up period was 11.2 months. One patient experienced recurrence of left SP three weeks after the surgery and underwent pleural abrasion.
  
  
  CONCLUSIONS
  Bilateral bullectomy through uniportal VATS combined with contralateral access to the anterior mediastinum is technically reliable and provides favorable surgical outcomes for patients with bilateral SP who develop bilateral apical bullae. However, among other requirements, this surgical procedure demands that surgeons be experienced in VATS and that the appropriate thoracoscopic instruments are available.
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Nan
authors.initials: N
authors.lastname: Song
authors.forename: Gening
authors.initials: G
authors.lastname: Jiang
authors.forename: Dong
authors.initials: D
authors.lastname: Xie
authors.forename: Peng
authors.initials: P
authors.lastname: Zhang
authors.forename: Ming
authors.initials: M
authors.lastname: Liu
authors.forename: Wenxin
authors.initials: W
authors.lastname: He
mesh_terms: D000293:Adolescent; D001768:Blister / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011012:Pneumomediastinum, Diagnostic / Q000295:instrumentation / Q000379:methods*; D011030:Pneumothorax / Q000601:surgery*; D012008:Recurrence; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult