Video-assisted Thoracoscopic Bullectomy Research Articles

Small cell lung carcinoma presenting initially with recurrent pneumothoraces: a case report

BackgroundPneumothorax is a non-physiological collection of air in the pleural space. Pneumothoraces can be broadly divided into Primary, Secondary, and Traumatic. Cancer of the lung is a known cause of secondary pneumothorax in both primary and metastatic lesions, however, pneumothorax as the presentation of lung cancer is exceedingly rare. Non-small cell lung carcinoma (NSCLC) has been reported in the literature to present with a pneumothorax, particularly in adeno/squamous cell carcinomas. It is almost completely unheard of for small cell lung carcinoma (SCLC) to present with a pneumothorax.Case PresentationWe present the case of a 62-year-old male patient, presenting twice in two months with spontaneous pneumothorax. The initial management involved admission and chest drain insertion. The patient has a past medical history of COPD and a significant smoking history. On the second admission, he underwent a video-assisted thoracoscopic (VATS) bullectomy and talc pleurodesis. The pathology report of the resected specimen confirmed SCLC with extensive infiltration. No gross evidence of metastatic spread was present on CT. Due to the R1 resection and significant risk of recurrence, the management plan included four cycles of adjuvant chemotherapy with carboplatin and etoposide, and radiotherapy as a consideration upon completion.ConclusionsPneumothorax as the presentation of lung cancer imparts a very poor prognosis, however the reasons for this are largely unknown. Furthermore, the mechanisms underlying spontaneous pneumothorax in lung cancer are also not well understood.

Pleurectomy versus pleural abrasion in patients with spontaneous pneumothorax: a randomized controlled trial

Background A prevalent clinical issue that can affect people of any age is pneumothorax. Depending on the degree of cardiorespiratory impairment, the severity of the symptoms, and the size of the pneumothorax, the course of treatment might range from conservative to surgical. In this study, we examined the risks of pneumothorax recurrence in individuals with spontaneous pneumothorax using the pleural abrasion and pleurectomy procedures. Patients and methods We did a randomized controlled trial involving 80 patients with spontaneous pneumothorax. Patients were randomly allocated to undergo video-assisted thoracoscopic surgery bullectomy with mechanical pleurodesis; pleural abrasion, or pleurectomy. We compared the incidence of recurrence of spontaneous pneumothorax as a primary outcome, postoperative drainage amount, hospital stay, and mortality as our secondary outcome in both groups. This trial is listed on ClinicalTrials.gov as NCT05407974. Results There were two cases of recurrence of pneumothorax in the pleurectomy group and no recurrence in the pleural abrasion group with P value of 0.152. The drainage amount was higher in the pleurectomy group with mean 230.00±75.79 ml than the abrasion group with mean 192.50±65.58 ml (P=0.020). There was no statistically significant difference between the two groups as regards hospital stay (P=0.556), there were no cases with hospital mortality in both groups. Conclusion Mechanical pleurodesis performed with bullectomy as a technique to reduce the recurrence of spontaneous pneumothorax has proven its efficiency in our study. Despite pleurectomy group showed increase in the drainage amount postoperatively compared with pleural abrasion. There was no difference in the recurrence rates, hospital stay, and in hospital mortality in both groups. Our conclusion does support the adoption of mechanical pleurodesis in patients undergoing bullectomy for spontaneous pneumothorax whether by pleurectomy or pleural abrasion.

Additional pleural painting with iodopovidone during video-assisted thoracoscopic bullectomy for primary spontaneous pneumothorax: an observational, single-center retrospective analysis

Background: Although video-assisted thoracoscopy is widely accepted as the gold-standard approach to treating primary spontaneous pneumothorax, the role of a chemical pleurodesis addition is still under debate. This retrospective study compared the results of pleurodesis with iodopovidone and talc following thoracoscopic bullectomy for spontaneous pneumothorax in a juvenile population.

Non-intubated video-assisted thoracoscopic bullectomy by paravetebral block and sedation.

Non-intubated video-assisted thoracoscopic bullectomy by paravetebral block and sedation.

Video-assisted thoracoscopic bullectomy with pleurectomy versus pleural abrasion in the treatment of primary spontaneous pneumothorax

Background Comparative study between partial pleurectomy and mechanical pleural abrasion in the treatment of primary spontaneous pneumothorax (PSP) by video-assisted thoracoscopy (VATS) to show its efficacy and safety. Patients and methods Between August 2014 and January 2018, 120 patients with PSP underwent VATS pleural abrasion and partial pleurectomy with bullectomy for both groups in the Security Force Hospital, Riyadh, KSA. All patients were reviewed retrospectively according to medical records. Results Partial pleurectomy was performed in 60 (50%) patients while other 60 patients underwent pleural abrasion. There is no significant differences in sex, age, weight, or history of smoking at the time of surgery. There was longer operative duration in the pleurectomy group (90±12.4 min) versus the pleural abrasion group (40±7.55 min) but with more blood loss in the latter one (P<0.001). There was no significant differences between studied groups regarding number, site, and size of bullae (P>0.05). There was no significant difference in major postoperative complications (P=0.132). Nine (7.5%) patients developed pneumothorax after surgery with mechanical pleurodesis. The incidence of recurrent pneumothorax in patients who underwent pleural abrasion was higher than in patients who underwent pleurectomy (13.3 vs. 1.7%, P=0.045). Conclusion In our study, VATS pleurectomy is more effective in the treatment of PSP than pleural abrasion. The recurrent rate of pneumothorax is significantly lower in the pleurectomy group than in the pleural abrasion group. So, VATS pleurectomy is the procedure of choose in the management of PSP.

Optimal margin distance of bullectomy for primary spontaneous pneumothorax reduces postoperative recurrence.

For primary spontaneous pneumothorax, bullectomy using autosutures is the standard procedure. Despite performing various methods for preventing postoperative recurrence, it remains relatively high. Although considering the margin distance of bullectomy is important, no argument has been discussed for the optical margin distance until now. Hence, we evaluated the optimal margin distance for bullectomy of spontaneous pneumothorax, bullectomy to reduce postoperative recurrence. Between March 2015 and May 2018, 91 eligible candidates from 142 cases, who underwent video-assisted thoracoscopic bullectomy for spontaneous pneumothorax, bullectomy, were evaluated. We analysed the factors preventing postoperative recurrence, including the margin distance using the inverse-probability of treatment weighted method by propensity score was used to adjust for heterogeneous patient backgrounds. The patients' median age was 20 years (range, 14-86 years). Postoperative recurrences occurred in 8 cases (8.8%). The margin distance was 9.1±5.0 mm. The cut-off point of the margin distance was defined as 5.0 mm. The inverse-probability of treatment weighted method indicated that a margin distance ≥5.0 mm significantly prevented postoperative recurrence (P=0.0076, hazard ratio =0.18). This study suggests that a margin distance of ≥5.0 mm for bullectomy of PSP can reduce postoperative recurrence.

New bullae formation in the staple line increases the risk of recurrent pneumothorax following video-assisted thoracoscopic surgery bullectomy for primary spontaneous pneumothorax.

The study aimed to investigate the association between the recurrence of pneumothorax following video-assisted thoracoscopic surgery (VATS) for primary spontaneous pneumothorax (PSP) and the formation of new bullae. This retrospective review examined patients who underwent VATS for PSP between April 2009 and December 2014. Of the 415 operated lungs, high-resolution computed tomography (HRCT) scans of 85 were analyzed. Of the 85 HRCT scans examined, 21 (24.7%) were diagnosed with recurrent pneumothorax and 60 new bullae were found. In total, 39 new bullae were located in the staple line, 38 were at other sites far from the staplers, and 17 were concurrent in the stapling and non-stapling areas. The group with new bullae in staple line exhibited significantly higher recurrence rate following VATS than the groups with no new bullae in the staple line (P=0.000, log-rank test). Cox regression analysis revealed that new bullae formation in the staple line [hazard ratio (HR), 26.664; P=0.003] and the volume of a resected pathology specimen (HR, 1.032; P=0.020) were independent risk factors for pneumothorax recurrence. New bullae formation in the staple line increases the risk of recurrent pneumothorax following VATS. Thus, the current concept of VATS bullectomy-resect with sufficient margin-warrants reconsideration.

VATS Partial Pleurectomy Versus VATS Pleural Abrasion: Significant Reduction in Pneumothorax Recurrence Rates After Pleurectomy

IntroductionSurgical treatment of primary spontaneous pneumothorax (PSP) usually consists of bullectomy and any form of pleurodesis to reduce risk of disease recurrence. Whether pleurectomy is superior to pleural abrasion is still a matter of debate with recurrence rates especially high when performed with a video-assisted thoracoscopic (VATS) approach. Aim of this study was to compare the efficacy of the two methods in prevention of recurrence of pneumothorax in a minimally invasive setting.Materials and methodsBetween 01/2005 and 12/2015, 107 patients younger than 40 years with PSP underwent VATS bullectomy and either partial pleurectomy or pleural abrasion. Medical records of patients were reviewed retrospectively.ResultsPleural abrasion was performed in 34/107 patients, 73/107 patients underwent partial pleurectomy. There were no statistically significant differences in age, sex, body mass index or smoking history at time of surgery. There was no significant difference in major postoperative complications (p = 0.3022). Nine (8.4%) patients had a recurrence of pneumothorax during follow-up. Incidence of recurrence in those undergoing pleural abrasion was significantly higher than those undergoing apical pleurectomy (8/34 vs. 1/73, p < 0.001). Surgical technique was the only factor associated with a recurrence of PSP after surgical intervention.DiscussionIn our analysis, a VATS partial pleurectomy proved to be effective for prevention of recurrent PSP. Recurrence rates were low despite a minimally invasive approach and significantly lower than in the pleural abrasion group. According to these findings, VATS pleurectomy might be considered as the primary choice for surgical pleurodesis in patients with PSP.

A clinical study of efficacy of polyglycolic acid sleeve after video-assisted thoracoscopic bullectomy for primary spontaneous pneumothorax.

Primary spontaneous pneumothorax (PSP) is a common disease in thoracic surgery, and a prolonged postoperative air leakage is the most frequent and troublesome early complication after video-assisted thoracoscopic (VATS) bullectomy. This study aimed to explore the efficacy of polyglycolic acid (PGA) sleeve in preventing postoperative air leakage after a VATS bullectomy for PSP. This study was a prospectively randomised clinical study. The patients who underwent a VATS bullectomy were continuously enrolled from January 2015 to June 2016 in the Beijing Chaoyang Hospital and were randomly assigned to the experimental and control groups. The experimental group applied a PGA sleeve combined with an automatic stapler in the bullectomy, while in the control group, the bullae were resected using an automatic stapler alone during the operation. In addition, the staple lines in both groups were covered with an absorbable polyglycolic acid sheet and both groups performed pleural abrasion after the resection. Useful clinical data were recorded, including the number of cases there was no air leakage immediately after the operation and air leakage lasted more than 3 days, the average postoperative air leakage, the drainage tube removal time, the postoperative hospital stay, the postoperative complications, and the postoperative recurrence. A total of 134 patients were enrolled in this study. The experimental group consisted of 60 subjects, and there were 74 in the control group. No operative related mortality was observed in either group. In the experimental group, 44 of the 60 patients did not have an air leakage immediately after the operation, which was significantly higher than the control group (73.33% vs. 54.05%, P=0.031). Compared with the control group, the average postoperative air leakage (0.57±1.11 days), the chest tube removal time (3.03±0.92 days), and the postoperative hospital stay (3.98±0.92 days) were all significantly shorter in the experimental group (P=0.048, P=0.012, and P=0.010, respectively). Moreover, the rate of postoperative complications in the experimental group was lower than the control group (3.33% vs. 16.22%, P=0.021). No postoperative recurrence was observed in either group during the follow-up period that ranged from 8 to 25 months. The use of PGA sleeve during surgery for PSP might effectively prevent early postoperative air leakage, as well as reduce the postoperative drainage tube removal time and the postoperative hospital stay.

Clinical application of near-infrared thoracoscope with indocyanine green in video-assisted thoracoscopic bullectomy.

Failure to identify all the possible bullous lesions was considered an important reason for the higher recurrence rate after the VATS bullectomy. We applied the latest near-infrared (NIR) thoracoscope with indocyanine green (ICG) to detect bullous lesions for patients with spontaneous pneumothorax. Two male patients with spontaneous pneumothorax and poorly identified bullae intraoperatively were included in this pilot study. An NIR thoracoscope with two different doses of ICG injection (0.2 and 0.6 mg/kg) was used to detect bullous lesions during VATS bullectomy. Partial lung resections of the bullous lesions were performed under syncretic mode. Data was managed with ImageJ software. No procedure-related complications were observed. The fluorescent signal was detected in normal lung tissue 10.5 seconds (mean, 10-11 seconds) after the ICG bolus, and lasted up to 525 seconds (mean, 480-570 seconds). The bullous lesions showed an obviously decreased fluorescent densities comparing to adjacent normal tissue. At the dosage of 0.6 mg/kg, ICG emits sufficient fluorescence to demonstrate the precise border of bullae, with the max SBR of 6.32. All resected specimens were confirmed as bullous lesions microscopically. NIR thoracoscope with intravenous ICG is a safe, accurate and real-time method to detect bullous lesions of lung tissue difficult to be found under normal light in human subjects. NCT02611245 (https://register.clinicaltrials.gov/).

Air leakage on the postoperative day: powerful factor of postoperative recurrence after thoracoscopic bullectomy.

Primary spontaneous pneumothorax (PSP) is a relatively common disorder in young patients. Although various surgical techniques have been introduced, recurrence after video-assisted thoracoscopic surgery (VATS) remains high. The aim of study was to identify the risk factors for postoperative recurrence after thoracoscopic bullectomy in the spontaneous pneumothorax. From January 2011 through March 2013, two hundreds and thirty two patients underwent surgery because of pneumothorax. Patients with a secondary pneumothorax, as well as cases of single port surgery, an open procedure, additional pleural procedure (pleurectomy, pleural abrasion) or lack of medical records were excluded. The records of 147 patients with PSP undergoing 3-port video-assisted thoracoscopic bullectomy with staple line coverage using an absorbable polyglycolic acid (PGA) sheet were retrospectively reviewed. The median age was 19 years (range, 11-34 years) with male predominance (87.8%). Median postoperative hospital stay was 3 days (range, 1-10 days) without mortality. Complications were developed in five patients. A total of 24 patients showed postoperative recurrence (16.3%). Younger age less than 17 years old and immediate postoperative air leakage were risk factors for postoperative recurrence after thoracoscopic bullectomy by multivariate analysis. Immediate postoperative air leakage was the risk factor for postoperative recurrence. However, further study will be required for the correlation of air leakage with recurrence.

Regulated drainage reduces the incidence of recurrence after uniportal video-assisted thoracoscopic bullectomy for primary spontaneous pneumothorax: a propensity case-matched comparison of regulated and unregulated drainage†.

To compare the recurrence rate of primary spontaneous pneumothorax (PSP) after uniportal video assisted thoracic surgery (VATS) bullectomy and mechanical pleurodesis in patients managed with a regulating pressure drainage system compared and those managed with a traditional one. Retrospective propensity score case-matched analysis of 174 consecutive patients submitted to uniportal VATS bullectomy and mechanical pleural abrasion (2007-13) in two centres. Definition of recurrence: Recurrent PSP requiring new treatment (i.e. aspiration, chest tube reinsertion, reoperation) within 12 months from the operation. All patients were managed with a single 24-Fr chest tube. Group 1 (106 patients): Tube connected to a traditional device (T) maintained on wall suction (-20 cmH2O) for 48 h. Group 2 (68 patients): Tube connected to a regulating pressure device (R) set at -20 cmH2O for 48 h. Chest tube removal criteria: No air leak (no bubbling or air flow <20 ml/min for at least 8 h) and pleural effusion <200 ml/day. Propensity score case-matching analysis was performed using the following variables: Age, gender, height, weight, side of operation, dystrophic score, length of stapled parenchyma. The two groups of 68 pairs were well matched for baseline and surgical characteristics. Patients of Group 2 (R) showed a significantly lower incidence of recurrence rate compared with matched counterparts (T) (3, 4.4 vs 10, 14%, P = 0.041). There were no differences in persistent air leak incidence, chest tube duration or hospital stay between the groups. Group 2 had a higher 48-h output of pleural effusion compared with Group 1 (P < 0.0001). By stabilizing the pleural pressure at the preset values, novel regulating pressure devices may enhance pleurodesis, leading to a reduced incidence of PSP recurrences after uniportal VATS bullectomy and pleural abrasion.

Low-cost biportal endoscopic surgery for primary spontaneous pneumothorax.

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. 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. 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. 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.

VATS bullectomy and apical pleurectomy for spontaneous pneumothorax in a young patient with Swyer-James-Mc Leod syndrome: case report presentation and literature review focusing on surgically treated cases

BackgroundSwyer-James-McLeod Syndrome (SJMS) is an uncommon, emphysematous disease characterized by radiologic hyperlucency of pulmonary parenchyma due to loss of the pulmonary vascular structure and to alveolar overdistension.Case reportWe herein describe a 15-year-old Caucasian patient with well-established SJMS since childhood who presented with spontaneous pneumothorax. Video-assisted thoracoscopic bullectomy with apical pleurectomy was performed. Since SJMS is considered an on-going inflammatory process, the patient one year after surgery exhibits excellent quality of life with no pneumothorax recurrence.

The development of tension pneumothorax during mask ventilation under general anesthetic induction.

Elevated peak inspiratory pressure (PIP) can cause pulmonary barotrauma during general anesthetic induction [1]. However, in patients who have bulla, tension pneumothorax can occur even if PIP is not highly elevated. We report a case of tension pneumothorax which occurred during anesthetic induction. The patient was a 67-year-old male scheduled for video-assisted thoracoscopic (VATS) bullectomy. He weighed 45 kg and was 163 cm tall. He was diagnosed with the human immunodeficiency virus (HIV) prior to pneumocystis pneumonia. His medical history included atrial fibrillation and chronic obstructive pulmonary disease (COPD). Physical examination revealed crackles and coarse lung sounds in both fields. Preoperative arterial blood gas analysis in room air showed a hydrogen ion concentration (pH) of 7.50, a partial pressure of arterial carbon dioxide (PaCO2) of 26 mmHg, a partial pressure of arterial oxygen (PaO2) of 71 mmHg, and an arterial oxygen saturation (SaO2) of 96%. Radiologic findings showed a sizeable cyst which had recently developed in the right lower lobe (Fig. 1). Pulmonary function test presented severe obstructive pattern possibly combined with restriction: predicted percentage of Forced expiration value after 1 second (FEV1) was 28%, predicted percentage of forced vital capacity (FVC) was 75%, and FEV1/FVC ratio was 28%. He arrived at the operating room without premedication. The vital signs prior to anesthetic induction were as followes: a blood pressure of 110–115/55–60 mmHg, an atrial fibrillation rhythm with a heart rate about 90 beats/min, and a peripheral oxygen saturation (SpO2) of 94% in room air. The left radial artery was cannulated with a 20-gauge catheter for continuous monitoring of systemic blood pressure. After preoxygenation, we administered 2% propofol with the Master target-controlled infusion (Orchestra Ⓡ Base Primea; Fresenius-MCM GmbH, Germany) after administration of lidocaine (40 mg). After confirming loss of consciousness, we administered rocuronium (0.5 mg/kg), and remifentanil TCI was started. Assisted and controlled ventilation using mask and reservoir bag with O2 6 L/min was applied. Airway pressure release valve was set in 20 cmH2O and PIP was maintained below 20 cmH2O during ventilation.

Nonsteroidal Antiinflammatory Medications: Efficient and Safe Treatment Following Video‐Assisted Pleurodesis for Spontaneous Pneumothorax

Recurrent spontaneous pneumothorax is widely treated by video-assisted thoracoscopic (VATS) bullectomy and pleurodesis. Treatment of postoperative pain with nonsteroidal antiinflammatory drugs (NSAIDs) is controversial as many surgeons believe that it reduces the efficacy of pleurodesis and increases the pneumothorax recurrence rate. In this retrospective study, we reviewed the hospital records for patients following VATS pleurodesis for recurrent spontaneous pneumothorax. The patients were divided into two groups: (1) NSAID group: patients were treated with NSAIDs for more than a week following surgery and (2) control group: patients did not receive NSAIDs. Data regarding short- and long-term outcomes were compared. The study cohort included 105 patients: 48 in the NSAID group and 57 in the control group. During the early postoperative period the average daily requirement of narcotic analgesia and the incidence of narcotic-related side effects were lower in the NSAIDs group. No difference was found in the long-term recurrence rate: two of 48 (4%) in the NSAID group and three of 57 (5%) in the control group. There was one case of early recurrence in the NSAID group. Both groups had similar length of stay with no cases of mortality or major morbidity. NSAIDs for postsurgical pleurodesis pain obviates the need for narcotics without increasing the pneumothorax recurrence rate. Prospective randomized controlled studies are needed to further investigate this issue.

Endobronchial valve migration

Endobronchial valves are increasingly used as a treatment modality as a less invasive alternative to lung volume reduction surgery in patients with severe emphysema. Endobronchial valves have also been used to treat patients with persistent pulmonary air leaks and those with bronchopleural fistulae. We report a case of a 61-year-old male with severe bullous emphysema. Following video-assisted thoracoscopic surgery and giant bullectomy, he had a persistent air leak. We inserted two endobronchial valves (in the lingular lobe and the anterior segment of the upper lobe) and the air leak ceased immediately. However, over the subsequent 5 months following the insertion of the endobronchial valves, the patient suffered recurrent chest infections and the endobronchial valves were found to have migrated to the orifice of the basal segment of the left lower lobe and the orifice of the basal segments of the right lower lobe.

The covering with forceps-assisted polymeric biodegradable sheet and endostapling method: a simplified technique for wide coverage and reinforcement of staple-line in video-assisted thoracoscopic bullectomy for spontaneous pneumothorax☆

Primary spontaneous pneumothorax is one of the most common diseases. To prevent recurrent pneumothorax after video-assisted thoracoscopic surgery, various methods of pleural covering with biodegradable polymers have been devised. In addition, using fibrin sealant should be avoided as far as possible because of its infectious aspect. Thus, we devised the covering with forceps-assisted polymeric biodegradable sheet and endostapling method in response to these demands. With this novel technique, we used non-woven polyglycolic acid (PGA) NEOVEIL® sheet (Gunze, Ayabe, Japan). A 5-mm cut was made in the center of the PGA sheet, which was then guided over the apical bulla with a lung forceps. The bulla was then pulled through the cut hole with the lung forceps, in a manner similar to the way a cape is worn through the head. To avoid stapling failure caused by wrinkling of the PGA sheet, we moistened the sheet with a few drops of saline before endostapling. The diseased lung tissue was resected by endostapling across the PGA sheet. After firing the endostapler, we could perform a sealing test by inflating the lung to detect persistent air leaks. This is a simple and reliable technique of staple-line reinforcement without fibrin glue.

Video-assisted thoracoscopic bullectomy and talc poudrage for spontaneous pneumothoraces: Effect on short-term lung function

We measured lung function before and after video-assisted thoracoscopic apical bullectomy and talc poudrage in patients with spontaneous pneumothoraces. Seventy-two patients were prospectively followed up for 12 months. The indications for surgery were recurrent pneumothoraces (n = 58), bilateral pneumothoraces (n = 8), and persistent air leak (n = 6). There were 46 males and 26 females with mean age of 29 years (range 15-61 years). The results were analyzed using paired t tests. There were no recurrences. There were 4 complications (5.6%): 1 wound infection, 1 case of pneumonia, and 2 persistent air leaks each lasting 1 week. There were no conversions to open surgery. Preoperative and 6-month pulmonary function test results were available on 41 patients, and 35 patients completed 12-month pulmonary function tests. Twelve-month values (mean percent ± SD) were as follows: Forced expiratory volume in 1 second fell from 95 ± 19 to 89 ± 16 (P = .02); forced expiratory volume in 1 second/forced vital capacity ratio was unchanged, 95 ± 12 versus 94 ± 13 (P = .9); total lung capacity fell from 106 ± 19 to 98 ± 12 (P = 0.002); vital capacity fell from 100 ± 22 to 96 ± 16 (P = .05); residual volume fell from 126 ± 32 to 107 ± 29 (P = .002); and diffusion capacity for carbon monoxide corrected for alveolar volume was unchanged, 88 ± 15 versus 91 ± 17 (P = .07). Flow rates and diffusion capacities were preserved, but lung volumes were slightly reduced at 1 year. Video-assisted thoracoscopic apical bullectomy and talc poudrage is an effective treatment for spontaneous pneumothoraces with a low complication rate and recurrence rate and only minor changes in pulmonary function at 1 year.

Hemothorax from the stapled line after video-assisted thoracoscopic bullectomy

A 17-year-old man underwent video-assisted thoracoscopic (VATS) bullectomy because of recurrent, spontaneous pneumothorax of the left lung. However, 6 h later, gradually, 500 mL of bloody fluid was seen. The bloody fluid continued to drain, so we decided on an emergency reoperation. Continuous bleeding was present along a line consistent with the stapled line of the edge of segment 6. We performed a VATS wedge resection with the edge of segment 6 folded up. Postoperatively, recovery was uneventful. Some reports demonstrated that intrapulmonary bleeding occurred late, at the stapled line. However, to our knowledge there has been no previous report on hemothorax just after surgery. This is the first report of hemothorax at the stapled line, developing after VATS bullectomy.