Abstract
Background Patients with secondary pneumothoraces generally have serious comorbid disease and poor pulmonary function and require that treatment be individualized. Though interventional treatments such as tube thoracostomy and pleurodesis are to be selected first, some cases become obstinate. Even though VATS treatment is attempted ultimately, sometimes it turned out to be inadequate for stapling or simple suturing. We present here our new VATS technique to control refractory air leak by direct infusion of fibrin glue (FG) via double lumen catheter and additional insertion of pieces of PGA (polyglycolic acid) sheet into ruptured bulla alternately.
Highlights
Patients with secondary pneumothoraces generally have serious comorbid disease and poor pulmonary function and require that treatment be individualized
We present here our new VATS technique to control refractory air leak by direct infusion of fibrin glue (FG) via double lumen catheter and additional insertion of pieces of PGA sheet into ruptured bulla alternately
1) VATS is introduced with general anesthesia, 2) detect the responsible focus, 3) confirm that stapling is not good for the lesion, 4) ensure surgical margin to afford loop tie, 5) enlarge the air-leak hole or make a new hole to introduce a catheter, 6) FG infusion via a double lumen catheter, 7) a piece of PGA sheet insertion by endoscopic forceps, 8) tie the catheter insertion site, 9) pleurodesis is added
Summary
Patients with secondary pneumothoraces generally have serious comorbid disease and poor pulmonary function and require that treatment be individualized. Video-assisted thoracoscopic layered insertion of fibrin glue and polyglycolic acid sheet directly into ruptured bulla associated refractory secondary pneumothorax K Okabayashi*, A Nagata, T Higuchi, T Hamada From 23rd World Congress of the World Society of Cardio-Thoracic Surgeons Split, Croatia.
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