# Spontaneous Pneumothorax — GCMD Library living collection

Everything in the library about spontaneous pneumothorax — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 66 cited statements

## Episodes
### Surgical Management
- [Update Course Rewind 2021 - Updates in Pectus](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411) — video · 61:14 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411.md)

### Case-Based Learning
- [Supine Positioning for Bilateral VATS: Pediatric Surgery Difficult...](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432) — video · 15:50 · [machine version](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432.md)
- [Tricks - Supine Positioning For Bilateral VATS](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638) — video · 17:04 · [machine version](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638.md)

## Chapters
- [0:03](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=3) Case Presentation: Bilateral VATS in Supine Position (Ep 1)
- [4:07](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=247) Patient Selection and Indications for Supine Bilateral VATS (Ep 1)
- [7:14](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=434) Technical Considerations: Positioning and Lung Collapse (Ep 1)
- [10:04](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=604) Pleurodesis Techniques and Necessity Debate (Ep 1)
- [0:00](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=0) Case Presentation: Bilateral Supine VATS for Spontaneous Pneumothorax (Ep 2)
- [5:20](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=320) Indications and Patient Selection for Supine VATS (Ep 2)
- [9:15](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=555) Technical Details: Double-Lumen Intubation and Exposure (Ep 2)
- [11:28](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=688) Pleurodesis Techniques: Mechanical, Chemical, and Pleurectomy Debate (Ep 2)
- [0:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=0) Introduction and Initial Polling on Pain Control (Ep 3)
- [2:37](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=157) Cryoanalgesia Advocacy and Evidence (Ep 3)
- [9:33](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=573) Skepticism About Cryoanalgesia Long-term Safety (Ep 3)
- [17:13](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1033) Cryoanalgesia Rebuttal and Registry Discussion (Ep 3)
- [20:41](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1241) ERAS Protocol as Alternative to Regional Anesthesia (Ep 3)
- [25:56](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1556) Epidural Catheter Discussion and Erector Spinae Catheters (Ep 3)
- [31:37](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1897) Activity Restrictions and Bar Flippage (Ep 3)
- [35:21](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2121) Bar Length Selection and Shorter Bar Technique (Ep 3)
- [40:50](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2450) Sternal Elevator and Sub-xiphoid Techniques (Ep 3)
- [47:23](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2843) Right-to-Left Versus Left-to-Right Bar Passage (Ep 3)
- [53:13](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=3193) Management of Spontaneous Pneumothorax Before Nuss (Ep 3)
- [58:38](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=3518) Magnetic Repair Update and Closing (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "In a randomized trial of 110 patients comparing epidural to PCA, maximum pain scores did not drop off in the epidural group due to day 2-3 transition pain, whereas PCA group pain decreased over 4.5 days." — Shawn St. Peter (clinical) [Ep 3 · 3:27](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=207)
- "Cryotherapy technique involves freezing ribs 4 through 7 for two minutes per rib; should not go to rib 8 or below due to risk of abdominal wall paralysis." — Shawn St. Peter (clinical) [Ep 3 · 6:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=380)
- "In prospective observational cryoanalgesia study, six of nine patients in initial retrospective cohort went home on post-op day one." — Shawn St. Peter (clinical) [Ep 3 · 7:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=440)
- "With cryoanalgesia, length of stay that couldn't get below four days became one day, with tight range except for occasional failures that look like traditional four-day stays." — Shawn St. Peter (clinical) [Ep 3 · 7:55](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=475)
- "Median morphine equivalents with cryoanalgesia versus traditional approaches are not on the same planet in terms of magnitude of difference." — Shawn St. Peter (clinical) [Ep 3 · 8:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=510)
- "Medical devices and implants are not required to undergo clinical trials before market introduction, unlike drugs." — Victor Garcia (guideline) [Ep 3 · 10:40](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=640)
- "Cryotherapy devices received FDA approval via 510(k) predicate pathway based on similarity to devices from 1976, not based on clinical trials." — Victor Garcia (guideline) [Ep 3 · 14:10](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=850)
- "With erector spinae catheters, hospital stay is two days with reduced opioid requirements both in-hospital and post-discharge." — Victor Garcia (clinical) [Ep 3 · 28:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1700)
- "When bars flip, it is always technical - related to bar sitting in funky inner space, bad spot, not wrapped tight enough, or not secured well - not related to patient activity or pain modality." — Shawn St. Peter (opinion) [Ep 3 · 30:50](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1850)
- "Activity restrictions beyond two weeks post-Nuss can be liberalized to anything the patient can handle, including bull riding, boxing, football, and hockey." — Shawn St. Peter (clinical) [Ep 3 · 29:24](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1764)
- "In Texas Children's study, 50% of patients still take opioids two weeks after Nuss procedure." — Justin Wagner (host_summary) [Ep 3 · 24:10](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1450)
- "In past five years, hospital length of stay for Nuss procedures has been cut in half through protocol improvements." — Justin Wagner (host_summary) [Ep 3 · 24:40](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1480)
- "In Nebraska protocol without epidurals, catheters, or cryo, length of stay is under two days and patients are off opioids by one week." — Justin Wagner (host_summary) [Ep 3 · 25:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1520)
- "In Texas Children's study, urinary retention was 8% in cryo group versus 34% in non-cryo group." — Justin Wagner (host_summary) [Ep 3 · 26:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1560)
- "Bar flippage occurs almost eight times more commonly in cryo group, and allodynia/neuropathy occurs about six times more frequently in cryo group." — Justin Wagner (host_summary) [Ep 3 · 26:25](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1585)
- "In randomized epidural trial, epidural could either not be placed or was removed after one day in approximately 25% of patients." — Whit (host_summary) [Ep 3 · 26:55](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1615)
- "Adult experience using cryotherapy with thoracotomies goes back 20 years without high enough incidence of complications to warrant backing away from the treatment advantage." — Shawn St. Peter (epidemiological) [Ep 3 · 19:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1140)
- "With cryoanalgesia, 70% of patients go home on post-op day one without narcotics." — Steven Rothenberg (clinical) [Ep 3 · 34:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2040)
- "Sternal elevator is used in about 10% of cases, primarily in older males with deep, stiff pectus where flexibility is limited." — Steven Rothenberg (clinical) [Ep 3 · 45:50](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2750)
- "In updated series of 554 patients, bar rotation rate was 0.7%, with most occurring within first few years of surgeon experience." — Shawn St. Peter (epidemiological) [Ep 3 · 39:16](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2356)
- "Pilegaard technique uses shorter bars placed asymmetrically with right side covering two rib spaces and left side with single stabilizer, resulting in well below 1% bar flip rate." — Justin Wagner (host_summary) [Ep 3 · 37:19](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2239)
- "Computational modeling shows flatter bars focus stress on sternum while bigger curved bars have parasitic forces causing unwanted horizontal and torque action at bar ends." — Justin Wagner (host_summary) [Ep 3 · 38:10](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2290)
- "Sub-xiphoid dissection technique allows palpation-guided bar passage and has resulted in 0% incidence of pericarditis." — Shawn St. Peter (clinical) [Ep 3 · 43:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2600)
- "Many patients have normal anterior chest sensation even in early post-op phase (two to three weeks) after cryoanalgesia, suggesting nerve stunning rather than complete death." — Shawn St. Peter (clinical) [Ep 3 · 18:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1100)
- "Gabapentin is most commonly given once pre-op then 200-300mg three times daily for up to one week post-op; pharmacokinetics suggest starting several days before operation for peak effect." — Justin Wagner (clinical) [Ep 3 · 22:40](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1360)
- "When passing bar from left chest to right chest, the angle avoids pointing directly at the ventricle compared to right-to-left passage." (clinical) [Ep 3 · 41:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2480)
- "In 15-patient magnetic repair trial, magnets were safe to place in children's chests and well-tolerated, but results were not as effective as hoped; appears most effective in young children with flexible chests." — Shawn St. Peter (clinical) [Ep 3 · 59:24](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=3564)
- "Lateral decubitus positioning was adopted from the transition from open thoracotomy to VATS but may add unnecessary morbidity including brachial plexus injury and decubitus ulcers." (host_summary) [Ep 1 · 0:03](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=3)
- "The presented case involved a 17-year-old male with asthma presenting with shortness of breath and chest tightness when running, found to have bilateral apical blebs and a large right spontaneous pneumothorax treated with chest tube, followed by a small left spontaneous pneumothorax that resolved with observation." (host_summary) [Ep 1 · 0:30](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=30)
- "Bilateral VATS with bilateral apical bleb resections and mechanical pleurodesis was performed in supine position with single sterile preparation, reducing operative time." (host_summary) [Ep 1 · 1:30](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=90)
- "Port placement for the right side included 25mm ports at the 7th intercostal space midclavicular line and 6th intercostal space mid-axillary line, plus a 12mm port at the 4th intercostal space mid-axillary line to accommodate the GIA stapler." (host_summary) [Ep 1 · 2:00](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=120)
- "Patient selection for supine bilateral VATS should include procedures with low morbidity and very well-defined pathology such that you won't encounter any surprises." — Nick (opinion) [Ep 1 · 4:54](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=294)
- "Bilateral thoracic sympathectomies for hyperhidrosis can be performed in supine position at one sitting." — Jose (clinical) [Ep 1 · 5:15](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=315)
- "For sympathectomy in supine position, the lung falls away adequately with table tipping and CO2 compression of the lung to help with exposure." — Jose (clinical) [Ep 1 · 6:04](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=364)
- "Supine VATS is useful in low-risk to conversion thoracoscopic cases and applicable for low-risk pleural-based lesion cases, superficial wedge resections, or biopsies." — Mark McCollum (opinion) [Ep 1 · 6:41](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=401)
- "If there's a high risk of conversion or difficulty with exposure, traditional decubitus position is preferred over supine." — Mark McCollum (opinion) [Ep 1 · 7:14](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=434)
- "Bilateral phrenic nerve stimulators for patients with central hyperventilation syndrome is a good candidate for supine bilateral VATS because the phrenic nerve is quite anterior." — Sharif (clinical) [Ep 1 · 8:00](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=480)
- "A double-lumen tube was used with positive pressure in the chest being worked on, providing great exposure." — Mark McCollum (clinical) [Ep 1 · 9:09](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=549)
- "Mechanical pleurodesis was performed from about the 5th rib intercostal space up to the apex, circumferentially, and was as easy as the standard decubitus approach." — Mark McCollum (clinical) [Ep 1 · 9:09](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=549)
- "Parietal pleurectomy is fairly easy once you get into the space underneath the parietal pleura and is a far more effective way to seal the pleural cavity than mechanical pleurodesis." — Jack (opinion) [Ep 1 · 10:13](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=613)
- "Recurrences have been seen after mechanical pleurodesis, but no recurrences have occurred after pleurectomy in one surgeon's experience." — Jack (clinical) [Ep 1 · 10:40](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=640)
- "Blood patch technique is very effective for pleurodesis, and blood should not be suctioned out during the procedure." — Jack (clinical) [Ep 1 · 10:57](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=657)
- "Pleurodesis may not be necessary after bleb resection because the cause of pneumothorax is blebs in the apex of the lung, and removing the blebs should prevent recurrent pneumothorax." — Todd Ponsky (host_summary) [Ep 1 · 11:25](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=685)
- "Blebs are not just a one-point-in-time thing but relate to lung anatomy and overstretch, so removing one bleb does not prevent another from forming in a few months." — Jack (opinion) [Ep 1 · 11:43](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=703)
- "Blebs are congenital and do not form over time at age 16; they become problematic during growth in the preteens." — Sharif (opinion) [Ep 1 · 11:55](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=715)
- "In certain congenital problems, blebs can be present all over the chest, with the largest ones at the apex assumed to be the ones that burst, but blebs may exist that cannot be seen or identified." — Kathy (clinical) [Ep 1 · 12:22](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=742)
- "A prospective randomized trial comparing blebectomy with pleurodesis versus blebectomy without pleurodesis could determine if there is a higher incidence of recurrence without pleurodesis." — Todd Ponsky (host_summary) [Ep 1 · 12:59](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=779)
- "Pleurectomy is incredibly painful postoperatively." — Todd Ponsky (host_summary) [Ep 1 · 13:34](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=814)
- "Patients receiving talc pleurodesis had more postoperative pain compared to mechanical pleurodesis in one surgeon's anecdotal experience." — Todd Ponsky (host_summary) [Ep 1 · 13:52](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=832)
- "Pleurectomy and talc pleurodesis are very painful postoperatively, and re-operating in a chest that has had talc is extremely difficult due to the entire lung being frozen." — Mark McCollum (clinical) [Ep 1 · 14:17](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=857)
- "Mechanical pleurodesis works effectively by causing only the apex of the lung to adhere, which may be sufficient to prevent tension pneumothorax without freezing the entire chest." — Mark McCollum (opinion) [Ep 1 · 14:45](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=885)
- "In the presented case, the area where the previous bleb had spontaneously erupted was well adhered to the apex of the chest when the right side was started." — Mark McCollum (clinical) [Ep 1 · 14:45](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=885)
- "Parietal pleurectomy, once started, is hard to stop because it strips away easily, and postoperative pain is manageable with modern analgesics." — Jack (clinical) [Ep 1 · 15:14](https://qa.library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=914)
- "Lateral decubitus positioning has been adopted from the transition from open thoracotomy to VATS and provides ease of exposure and rapid conversion to open thoracotomy, but with advancements in VATS this no longer applies." — Nick Bruns (opinion) [Ep 2 · 0:45](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=45)
- "Lateral positioning may add unnecessary morbidity including brachial plexus injury and decubitus ulcers." — Nick Bruns (clinical) [Ep 2 · 1:30](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=90)
- "The patient is a 17-year-old male with history of asthma who presented with shortness of breath and chest tightness when running, found to have bilateral apical blebs and a large right spontaneous pneumothorax treated with chest tube, later developing a small left spontaneous pneumothorax that resolved with observation." — Nick Bruns (clinical) [Ep 2 · 1:40](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=100)
- "Bilateral VATS with bilateral apical bleb resections and mechanical pleurodesis was performed in the supine position due to the routine nature of the procedure." — Nick Bruns (clinical) [Ep 2 · 2:20](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=140)
- "Port placement for supine VATS included 25mm ports at the 7th intercostal space midclavicular line and 6th intercostal space mid-axillary line, plus a 12mm port at the 4th intercostal space mid-axillary line to accommodate the GIA stapler." — Nick Bruns (clinical) [Ep 2 · 2:40](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=160)
- "Bilateral VATS was safely completed in the supine position, providing simplicity, convenience, decreased operative time, and decreased positioning-related morbidity." — Nick Bruns (opinion) [Ep 2 · 4:40](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=280)
- "Patient selection for supine VATS is important; appropriate cases include bilateral VATS with low morbidity and well-defined pathology where you won't encounter surprises." — Nick Bruns (clinical) [Ep 2 · 6:09](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=369)
- "Bilateral thoracic sympathectomies for hyperhidrosis can be performed in the supine position at one sitting." — Jose (clinical) [Ep 2 · 6:30](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=390)
- "For sympathectomy in supine position, the lung falls away adequately with table tipping and CO2 compression of the lung to help with exposure." — Jose (clinical) [Ep 2 · 7:19](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=439)
- "Supine VATS is useful in low-risk-to-conversion thoracoscopic cases; any low-risk pleural-based lesion case for biopsy or superficial wedge resection would be applicable, but if there's high risk of conversion or difficulty with exposure, traditional decubitus positioning is preferred." — Mark McCollum (clinical) [Ep 2 · 7:58](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=478)
- "Bilateral phrenic nerve stimulators for patients with central hyperventilation syndrome can be placed in supine position because the phrenic nerve is quite anterior." — Sharif (clinical) [Ep 2 · 9:15](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=555)
- "In the presented case, a double-lumen tube was used with positive pressure in the chest being worked on, providing great exposure." — Mark McCollum (clinical) [Ep 2 · 10:34](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=634)
- "Mechanical pleurodesis was performed circumferentially from about the 5th intercostal space up to the apex, which was as easy as the standard approach with decubitus positioning." — Mark McCollum (clinical) [Ep 2 · 10:34](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=634)
- "The patient was moved to the side edge of the bed to allow full mobility of the surgeons' hands." — Mark McCollum (clinical) [Ep 2 · 10:34](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=634)
- "Parietal pleurectomy is fairly easy—you get into the space underneath the parietal pleura and strip it off—and is a far more effective way to seal the pleural cavity than mechanical pleurodesis." — Jeff Blair (opinion) [Ep 2 · 11:28](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=688)
- "There have been recurrences after mechanical pleurodesis, but no recurrences after pleurectomy in the speaker's experience." — Jeff Blair (clinical) [Ep 2 · 11:28](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=688)
- "The blood patch technique is very effective for pleurodesis, and you don't want to suction out any blood for this reason." — Jack (clinical) [Ep 2 · 12:12](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=732)
- "Pleurodesis may not be necessary in these cases because the cause of the problem is blebs in the apex of the lung; removing the blebs should prevent recurrent pneumothorax." — Jack (opinion) [Ep 2 · 12:40](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=760)
- "Blebs are not just a one-point-in-time thing; they have to do with the anatomy of the lung and overstretch, so if you take out one bleb, another bleb could form in a few months." — Jack (opinion) [Ep 2 · 12:57](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=777)
- "These are congenital blebs that don't form over time at age 16." — Jack (opinion) [Ep 2 · 13:10](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=790)
- "There are certain congenital problems where you go in and there are blebs all over the place; you see the largest ones at the apex and assume those burst, but you can have blebs you can't see or identify." — Cathy (clinical) [Ep 2 · 13:35](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=815)
- "The speaker strips the cupola of the pleura and uses the abrading technique for the lower aspects of the chest where stripping becomes harder." — Cathy (clinical) [Ep 2 · 13:35](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=815)
- "Pleurectomy is incredibly painful postoperatively." — Jeff Blair (clinical) [Ep 2 · 14:34](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=874)
- "Patients who received talc pleurodesis had more pain postoperatively compared to mechanical pleurodesis, based on anecdotal observation." — Sharif (clinical) [Ep 2 · 15:05](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=905)
- "Pleurectomy and talc are very painful postoperatively, and if you've ever had to re-operate in a chest that's had talc in it, you'll never do it again because the whole lung becomes frozen." — Mark McCollum (clinical) [Ep 2 · 15:32](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=932)
- "Mechanical pleurodesis works effectively because you just need the apex of the lung to stick up, not the whole lung frozen." — Mark McCollum (opinion) [Ep 2 · 15:32](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=932)
- "In the presented case, when starting on the right side, the area where the previous bleb had spontaneously erupted was well adhered to the apex of the chest." — Mark McCollum (clinical) [Ep 2 · 15:32](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=932)
- "The more painful the pleurodesis, probably the more effective it is." — Jack (opinion) [Ep 2 · 16:01](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=961)
- "Once you start pleurectomy, it's hard to stop because it strips away easily, and with modern analgesics the pain is manageable." — Jeff Blair (clinical) [Ep 2 · 16:29](https://qa.library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=989)

## Changelog
- Sep 15: 3 items added automatically

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