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 therefore 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 use of a Lucans trap works quite well for thoracoscopic application of talc

The talc is placed in the trap with a portion of tubing cut and attached to the spout, one side attached to the installation tubing and the other to one of the 5 millimeter trocars

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

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

It is important to keep the 2nd trocar open in order to maintain a pressure differential and promote flow

Adequate distribution results when a snowstorm effect is witnessed in the thoracic cavity

It is particularly important to confirm adequate coverage of the apical, visceral, and parietal pleura with talc

A 16 French chest tube is placed at procedure termination