title: Transcollation® technique in the thoracoscopic treatment of primary spontaneous pneumothorax.
abstract: OBJECTIVE
  The already low invasiveness of the thoracoscopic treatment of spontaneous pneumothorax may be further reduced by the transcollation® technique. Herein, we report our further experience with a new device, to coagulate blebs and bullae, compared with contrast to endostapler resection.
  
  
  METHODS
  Data of patients with recurrent or persistent spontaneous pneumothorax, who underwent thoracoscopic treatment, were prospectively collected and reviewed. Those with blebs or bullae (Stages III and IV in accordance with Vanderschueren's classification) were treated with a new device, based on coupling saline solution perfusion with radiofrequency energy. The combination of fluid with radiofrequency allows the sealing of tissue, avoiding charring or burning. Most operations were performed through two 1-cm incisions only.
  
  
  RESULTS
  From 2005 to 2010, 73 patients were treated. These were 59 males (80.8%) and 14 females (19.2%), with a mean age of 27.9 years [standard deviation (SD): 11.7]. Forty-three patients underwent general anaesthesia with selective intubation, 9 awake epidural anaesthesia and 21 spontaneous breathing anaesthesia with laryngeal mask. The mean operation time was 31 min (SD: 10.2). The median postoperative drainage period and hospital stay were 2 days (range of 1-11) and 3 days (range of 2-11), respectively. Prolonged air leak occurred in 1 patient (1.4%). Over a mean follow-up period of 60 months (SD: 22.5), two recurrences (2.7%) were reported.
  
  
  CONCLUSIONS
  The transcollation® technique by cold coagulation of blebs and bullae seems to be effective in the treatment of primary spontaneous pneumothorax. Owing to its potential advantages, it appears to be particularly suitable to be associated with awake epidural and LMA anaesthesia.
authors.affiliation: Department of Surgical Medical Molecular and Critical Area Pathology, Thoracic Surgery Unit, University of Pisa, Pisa, Italy.
authors.forename: Marcello Carlo
authors.initials: MC
authors.lastname: Ambrogi
authors.affiliation: Department of Surgical Medical Molecular and Critical Area Pathology, Thoracic Surgery Unit, University of Pisa, Pisa, Italy c.zirafa@gmail.com.
authors.forename: Carmelina Cristina
authors.initials: CC
authors.lastname: Zirafa
authors.affiliation: Department of Surgical Medical Molecular and Critical Area Pathology, Thoracic Surgery Unit, University of Pisa, Pisa, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Davini
authors.affiliation: Department of Surgical Medical Molecular and Critical Area Pathology, Thoracic Surgery Unit, University of Pisa, Pisa, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Giarratana
authors.affiliation: Department of Surgical Medical Molecular and Critical Area Pathology, Thoracic Surgery Unit, University of Pisa, Pisa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Lucchi
authors.affiliation: Department of Surgical Medical Molecular and Critical Area Pathology, Thoracic Surgery Unit, University of Pisa, Pisa, Italy.
authors.forename: Olivia
authors.initials: O
authors.lastname: Fanucchi
authors.affiliation: Department of Surgical Medical Molecular and Critical Area Pathology, Thoracic Surgery Unit, University of Pisa, Pisa, Italy.
authors.forename: Franca
authors.initials: F
authors.lastname: Melfi
authors.affiliation: Department of Surgical Medical Molecular and Critical Area Pathology, Thoracic Surgery Unit, University of Pisa, Pisa, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Mussi
mesh_terms: D000293:Adolescent; D000328:Adult; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D001768:Blister / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004322:Drainage; D019723:Endoscopes; D004867:Equipment Design; D005260:Female; D006801:Humans; D017214:Laryngeal Masks; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011030:Pneumothorax / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012008:Recurrence; D007507:Therapeutic Irrigation; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Coagulation; New technology; Spontaneous pneumothorax; Surgical treatment; Thoracoscopy; Video-assisted thoracic surgery