title: Small Single-Incision Thoracoscopic Surgery Using an Anchoring Suture in Patients With Primary Spontaneous Pneumothorax: A Safe and Feasible Procedure.
abstract: BACKGROUND
  Single-incision thoracoscopic surgery is an alternative procedure used to treat primary spontaneous pneumothorax, although conventional three- or four-port video-assisted thoracoscopic surgery is the recognized standard procedure. Single-incision thoracoscopic surgery is not yet popular when a wedge resection is required during general thoracic surgery, including pneumothorax surgery and lung biopsy, because of the danger of collision between instruments during surgery. In addition, introducing all of the instruments through a single incision means that a relatively large incision is required, leading to less than satisfactory cosmetic outcomes. The purpose of this study was to show that our in-house surgical method is a safe, alternative procedure for treating a primary spontaneous pneumothorax.
  
  
  METHODS
  A total of 104 patients underwent our in-house surgical procedure to treat primary spontaneous pneumothorax from October 2012 to October 2014. Mean patient age was 22.7 ± 8.8 years; 91 patients were male and 13 were female. We used a wound protector intraoperatively, and placed an anchoring suture at the point of the bleb lesion, permitting us to retract the lung, which enabled us to create a small skin incision (<2 cm). We only inserted a stapler and the scope through this small incision when we performed the wedge resection; no lung manipulation (normally requiring instrumentation) was necessary. A total of 107 surgeries were performed (3 patients experienced contralateral recurrences). All clinical data were analyzed retrospectively.
  
  
  RESULTS
  Mean operative time (107 surgeries) was 49.7 ± 13.9 minutes, and the mean duration of thoracic catheter insertion was 4.1 ± 1.0 days. Three cases were converted to two- or three-port video-assisted thoracoscopic surgery during the operation. Three patients experienced prolonged air leakage (>5 days). No other complication was recorded. The Wong-Baker pain scores on postoperative days 0, 1, and 2 were 2.4 ± 1.0, 2.3 ± 1.3, and 1.7 ± 0.83, respectively. The mean duration of postoperative hospital stay was 4.8 ± 1.7 days. The mean follow-up period was 11 ± 6 months. Twelve patients experienced chest wall paresthesia (11.2%). One ipsilateral pneumothorax recurrence was encountered during follow-up.
  
  
  CONCLUSIONS
  Small (<2 cm) single-incision thoracoscopic surgery using a wound protector and a bidirectional anchoring suture was safe and feasible and yielded acceptable outcomes for treating primary spontaneous pneumothorax.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, Gyoungnam, South Korea.
authors.forename: Bong Soo
authors.initials: BS
authors.lastname: Son
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, Gyoungnam, South Korea. Electronic address: yumccs@nate.com.
authors.forename: Do Hyung
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, Gyoungnam, South Korea.
authors.forename: Sang Kwon
authors.initials: SK
authors.lastname: Lee
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, Gyoungnam, South Korea.
authors.forename: Chang Wan
authors.initials: CW
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D010149:Postoperative Pain / Q000517:prevention & control; D011030:Pneumothorax / Q000601:surgery*; D053441:Suture Anchors; D013906:Thoracoscopy / Q000379:methods*; D055815:Young Adult