Thoracoscopic Treatment of Spontaneous Pneumothorax

The patient is an 18 year old male who had sudden onset of right chest pain and dyspnea, leading to a diagnosis of right spontaneous pneumothorax on chest X-ray

He had undergone thoracoscopic treatment of a left spontaneous pneumothorax approximately 2 years earlier after failed non-operative management

A decision was made to proceed directly to surgical treatment of the right side without an attempt at catheter thoracostomy

The patient is placed in the lateral decubitus position with an axillary roll on a beanbag

Three triangulating incisions are used: 2 for 5 millimeter ports, and a third, more anterior one for direct insertion of a 12 millimeter endo GIA stapler

The stapler did not capture an adequate margin under the blebs on the posterior surface on initial firing

The stapler is applied across a more generous margin of grossly normal lung tissue after retracting the apex upwards

Two more firings are necessary to completely remove the apical wedge after the first firing is insufficient

A pressure of 15 millimeters of mercury and a flow of 4 L per minute is used to insufflate the talc

A 16 French chest tube is placed at procedure termination