title: Low-cost biportal endoscopic surgery for primary spontaneous pneumothorax.
abstract: BACKGROUND
  Like many other countries, including the United States, China faces the problem of rising health care costs, which have become a heavy burden on the state and individuals. Endoscopic surgery offers many benefits. However, the need for more expensive endoscopic consumables brings further high medical costs. Therefore, the development of video-assisted thoracic surgery with no disposable consumables will help to control medical cost escalation.
  
  
  METHODS
  Between October 2011 and September 2014, a series of 66 patients with primary spontaneous pneumothorax underwent hand ligation of blebs under biportal video-assisted thoracoscopic surgery or bullectomy with stapler during triportal video-assisted thoracoscopic surgery. After treatment of blebs, pleural abrasion was performed with an electrocautery cleaning pad.
  
  
  RESULTS
  Compared with the group treated by bullectomy with stapler, we found a significant reduction in postoperative costs in the group with bleb ligation. There was no difference in operating time, chest tube drainage, and postoperative stay between the two groups. The follow-up period varied from 1 to 35 months and six cases of recurrence were noted.
  
  
  CONCLUSIONS
  The technique that we described appears to offer better economic results than bullectomy with a stapler under three-port video-assisted thoracoscopic surgery for treating primary spontaneous. The clinical outcomes are similar.
authors.affiliation: Department of Cardiothoracic Surgery, First Affiliated Hospital of Guangxi Traditional Chinese Medical University, Nanning 530023, China.
authors.forename: Ansheng
authors.initials: A
authors.lastname: Mo
authors.affiliation: Department of Cardiothoracic Surgery, First Affiliated Hospital of Guangxi Traditional Chinese Medical University, Nanning 530023, China.
authors.forename: Yuzhong
authors.initials: Y
authors.lastname: Luo
authors.affiliation: Department of Cardiothoracic Surgery, First Affiliated Hospital of Guangxi Traditional Chinese Medical University, Nanning 530023, China.
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Yang
authors.affiliation: Department of Cardiothoracic Surgery, First Affiliated Hospital of Guangxi Traditional Chinese Medical University, Nanning 530023, China.
authors.forename: Shaoxiong
authors.initials: S
authors.lastname: Mo
authors.affiliation: Department of Cardiothoracic Surgery, First Affiliated Hospital of Guangxi Traditional Chinese Medical University, Nanning 530023, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Cardiothoracic Surgery, First Affiliated Hospital of Guangxi Traditional Chinese Medical University, Nanning 530023, China.
authors.forename: Yitong
authors.initials: Y
authors.lastname: Wei
keywords: Biportal video-assisted thoracic surgery; ligation; medical costs; primary spontaneous pneumothorax