Abstract
Recent advances in optical and endoscopic instruments for surgery have made it possible to perform operations for spontaneous pneumothorax under video-assisted thoracic conditions (VATS), and now VATS is the first choice of operating methods for the pneumothorax. VATS has several advantages such as less surgical stress, and VATS use for spontaneous pneumothorax is likely to increase in the future. A major problem of VATS for pneumothorax, however, is that the incidence of postoperative recurrence of pneumothorax with VATS is higher than with thoracotomy. The causes of such recurrences are the failure to seek other bullae with video-assisted thoracoscopy, the inadequate firing of the endostaplers, and the new development of bullae from damage to the lung owing to the use of the endostapler or endoforceps. In order to decrease this high incidence of recurrence, preoperative investigations of bullae by chest CT scan, administering an endostapler to a normal lung area at the base of the bullae, and treating the lung gently with endoforceps are all important. The use of VATS for pneumothorax is just beginning and will develop greatly if these precautions are taken.
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