Polyglycolic acid sheet with fibrin glue technique without pleural abrasion in uniportal VATS for primary spontaneous pneumothorax

Background: Uniportal video-assisted thoracoscopic surgery (VATS) for primary spontaneous pneumothorax (PSP) has demonstrated acceptable surgical outcomes while being less invasive than other surgical techniques. Fibrin glue-covered absorbable mesh has been applied to reinforce resected regions to prevent recurrence. We aimed to evaluate the outcomes of this technique without pleural abrasion in uniportal VATS for PSP. Methods: Between July 2012 and May 2017, 54 consecutive patients with PSP underwent uniportal VATS by a combination technique using a polyglycolic acid (PGA) sheet and fibrin glue without mechanical pleural abrasion. A bilateral approach was performed in five additional patients; thus, postoperative surgical outcomes of a total of 59 cases were analyzed. For subgroup analysis, we first divided the patients into a group of PGA sheet coverage, followed by additional fibrin glue application (n=36, Group A) and a group of fibrin glue injection prior to PGA sheet coverage (n=23, Group B). We reviewed the data and compared surgical outcomes to evaluate the efficacy of the application techniques. Results: There was a total 59 cases (43 males) with a median age of 18.0 years (range, 12-50 years) Demographic data revealed no differences between the two groups. There was no significant difference in operation time (41.8 +/- 10.1 vs. 41.3 +/- 8.8 minutes, P=0.821), length of hospital stay (4.1 +/- 1.3 vs. 3.8 +/- 1.1 days, P=0.411), or chest tube in-dwelling time (2.6 +/- 0.9 vs. 2.2 +/- 0.7 days, P=0.078) in the additional glue application and glue injection groups. Recurrence rates revealed no significant difference [2/36 (5.5%) vs. 1/23 (4.3%), P=0.837] between the two groups. There were neither conversions to multi-port VATS nor perioperative complications during a median follow-up period of 21.5 months. Conclusions: The combination method of the absorbable PGA sheet with fibrin glue established satisfactory outcomes without increasing morbidities, regardless of application technique. This simple technique is an effective procedure that does not require mechanical pleural abrasion or pleurodesis to prevent postoperative recurrences when conducting uniportal VATS for PSP.