title: Feasibility of single-incision thoracoscopic surgery using a modified chest wall pulley for primary spontaneous pneumothorax: a propensity score matching analysis.
abstract: OBJECTIVE
  Recently, single-incision thoracoscopic surgery (SITS) has been recognized as a favorable treatment choice for primary spontaneous pneumothorax (PSP) compared with conventional three-port video-assisted thoracoscopic surgery (VATS). However, conventional SITS bullectomy often results in collisions with surgical devices. Therefore, we devised a method of SITS using a chest wall pulley for lung excision (PulLE) and modified PulLE (mPulLE) system, which substitutes threads to eliminate such collisions. We compared the mPulLE system with conventional procedures using propensity score matching (PSM) to adjust for patient backgrounds.
  
  
  METHODS
  Using PSM, we evaluated the surgical results of 210 PSP patients who underwent VATS, including mPulLE (n = 23) and three-port VATS (n = 102), at our institution between January 2010 and August 2016.
  
  
  RESULTS
  We selected 17 mPulLE cases and 17 three-port VATS. There were no marked differences between the groups in the patient backgrounds or surgical results. However, there was a significant difference between the mPulLE cases and the three-port VATS cases in the operative time (71.7 ± 15.7 vs. 85.9 ± 25.5 min, respectively, P = 0.0388) and the number of autosutures used (3.6 ± 1.2 vs. 4.5 ± 1.2, respectively, P = 0.0178).
  
  
  CONCLUSIONS
  The surgical results of mPulLE in patients with PSP with multiple lesions were equivalent to those achieved with three-port VATS under the same conditions.
authors.affiliation: Department of Thoracic Surgery, Takasago Municipal Hospital, 33-1 Kamimachi, Arai Town, Takasago, Hyogo, 676-8585, Japan. drniwatori@smn.enjoy.ne.jp.
authors.forename: Kenji
authors.initials: K
authors.lastname: Tsuboshima
authors.affiliation: Department of Thoracic Surgery, Takasago Municipal Hospital, 33-1 Kamimachi, Arai Town, Takasago, Hyogo, 676-8585, Japan.
authors.forename: Machiko
authors.initials: M
authors.lastname: Nagata
authors.affiliation: Department of Thoracic Surgery, Takasago Municipal Hospital, 33-1 Kamimachi, Arai Town, Takasago, Hyogo, 676-8585, Japan.
authors.forename: Teppei
authors.initials: T
authors.lastname: Wakahara
authors.affiliation: Department of Thoracic Surgery, Takasago Municipal Hospital, 33-1 Kamimachi, Arai Town, Takasago, Hyogo, 676-8585, Japan.
authors.forename: Yasumi
authors.initials: Y
authors.lastname: Matoba
authors.affiliation: Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Maniwa
mesh_terms: D000293:Adolescent; D000328:Adult; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008168:Lung / Q000601:surgery*; D008297:Male; D011013:Pneumonectomy / Q000379:methods*; D011030:Pneumothorax / Q000601:surgery*; D057216:Propensity Score; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Modified; Pneumothorax; PulLE; Pulley; SITS