Less invasive needle thoracoscopic laser ablation of small bullae for primary spontaneous pneumothorax

Objective: The purpose of this study was to establish a new surgical technique of thoracoscopic laser ablation for the patients of primary spontaneous pneumothorax (PSP) with small bullae, by using endoscopic equipment with a 2-mm diameter. Method: According to the size of a bulla identified by high-resolution computed tomography (HRCT), we have a protocol to determine an indication; the conventional video-assisted thoracic surgery (VATS) procedure by both stapler bullectomy and laser ablation to visceral pleura surrounding the bulla (bullae size: greater than 2 cut), or a new VATS procedure using needle shaped thoracoscopy and endoscopic equipment with a 2-mm diameter (needle VATS) by laser bulla ablation alone (bullae size: less than 2 cm). Results: The conventional VATS was performed in 54 patients and needle VATS in 60 patients. In the needle VATS group, operation time was shorter than that of the VATS group (39 17 min vs. 56 +/- 22 min). Use of non-steroidal anti-inflammatory drugs for postoperative wound pain could be reduced in the needle VATS group (3% vs. 56%). There were no complications in the needle VATS group, but three complications (5.6%) in the VATS group, including prolonged air leakage (>4 days) in two and refractory intercostal pain in one. The rate of recurrence after the operation was similar in both,groups (3.7% vs. 3.3%). The needle VATS allowed wound healing without a scar and reduced the patient's cosmetic problems. Conclusion: The needle VATS procedure for patients with a bulla size less than 2-cm diameter was as useful as the conventional VATS procedure. (C) 2003 Elsevier Science B.V. All rights reserved.