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. 2019 Apr 11;14(1):71.
doi: 10.1186/s13019-019-0894-y.

Unilateral single-port thoracoscopic surgery for bilateral pneumothorax or pulmonary bullae

Xiaojian Li  1 , Xiaojin Wang  1 , Huayong Zhang  1 , Hua Cheng  1 , Qingdong Cao  2
Affiliations

Unilateral single-port thoracoscopic surgery for bilateral pneumothorax or pulmonary bullae

Xiaojian Li et al. J Cardiothorac Surg. .

Abstract

Background: Rapid rehabilitation surgery has become a widely accepted approach. Thoracic surgeons have attempted in many ways to make surgery less invasive. We combined tubeless technology, single-port technology and mediastinum approach for the treatment of simultaneous bilateral primary spontaneous pneumothorax(PSP)or pulmonary bullae. And we evaluated its therapeutic effect. This study aimed to investigate if tubeless single-port video-assisted thoracic surgery (Tubeless-SPVATS) via anterior mediastinum can be used as an alternative surgical treatment for bilateral lung diseases, especially for concurrent or contralateral recurrence PSP.

Methods: From November 2014 to December 2016, 18 patients with simultaneous bilateral PSP or pulmonary bullae were treated with tubeless -SPVATS via anterior mediastinum. They were 13 males and 5 females with an average age of 20.2 ± 2.3 years (17 to 24 years). They all had preoperative chest CT and were diagnosed with simultaneous bilateral PSP or pulmonary bullae.

Results: Fifteen patients underwent bilateral bullae resection with Tubeless-SPVATS via anterior mediastinum. Three patients underwent bilateral single-port video-assisted thoracic surgery. No thoracotomy was performed. No death and grade 3-4 mobidity were found. All the patients started eating 6 hours after surgery. The average operation time was 44.56±17.8min. The patients were discharged 3. 5±1.0 days postoperatively.

Conclusions: Tubeless-SPVATS via anterior mediastinum is a safe and feasible treatment for patients with simultaneous bilateral PSP or pulmonary bullae. However,contralateral thoracic is not explored fully enough. And when contralateral lung bullae are located near the hilum, endoscopic linear stapler cannot be easily used to conduct suture. Thus, the recurrence rate after performing Tubeless-SPVATS may be increased compared to performing thoracotomy. However, compared to bilateral thoracic surgery, this method reduced postoperative pain. And it took significantly less time than bilateral thoracic surgery. Thus, this method has some clinic value.

Keywords: Tubeless; mediastinum; pneumothorax; single-port; video-assisted thoracic surgery.

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Conflict of interest statement

Ethics approval and consent to participate

The study has been approved by ethics committee. For all research involving human subjects, informed consent to participate in the study had be obtained from participants。

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Wedge resection was used to resect the bullae
Fig. 2
Fig. 2
Used an Harmonic® knife or trench to open the anterior mediastinum pleura
Fig. 3
Fig. 3
Locate the specific location of the lesion (target surgical area)in the contralateral chest
Fig. 4
Fig. 4
Enter into the contralateral chest via anterior mediastinum, and resect the bullae
See this image and copyright information in PMC

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