HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Hui-Ping Liu Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Liu, H.-P. Articles by Hsieh, M.-J. Search for Related Content PubMed PubMed Citation Articles by Liu, H.-P. Articles by Hsieh, M.-J.

J Thorac Cardiovasc Surg 1997;113:50-054
© 1997 Mosby, Inc.

GENERAL THORACIC SURGERY

THORACOSCOPIC LOOP LIGATION OF PARENCHYMAL BLEBS AND BULLAE: IS IT EFFECTIVE AND SAFE?

Received for publication Feb. 9, 1996 Revisions requested April 8, 1996 Revisions received May 13, 1996 Accepted for publication June 4, 1996 Address for reprints: Hui-Ping Liu, MD, Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, 199, Tun-Hwa North Rd., Taipei, Taiwan, Republic of China.

Abstract

Surgeons who have gained experience and confidence with video-assisted thoracic surgery are now routinely applying the minimally invasive approach to treat patients with spontaneous pneumothorax. Although the endoscopic stapling device may be a preferred method for resection of parenchymal blebs or bullae, the stapling device is not inexpensive. In an effort to contain costs since we started performing the video-assisted thoracoscopic procedure in chest surgical diseases, we have used a self-made endoscopic loop as an alternative method. It has assisted us in performing bulla ablation in a cost-effective manner. Over a 4-year period (1992 to 1996), we assessed the efficacy of ligating parenchymal blebs and bullae with a self-made endoscopic loop by video-assisted techniques. A total of 263 ligations were performed in 250 patients. Surgical indications included recurrence (n = 146), bilaterality of the disease (n = 13), hemopneumothorax (n = 7), radiologically demonstrated large bulla (n = 9), persistent air leak (n = 52), and nonexpansion of the lung (n = 23). There were no operative deaths. Early postoperative complications included a dislodged endoscopic loop necessitating reexploration in one patient and postoperative minor wound infections in 13. The average postoperative hospitalization was 4.5 days. Two hundred seventeen patients (86.8% of all patients) were followed up for a median of 28 months (1 to 46 months) after the operation. There have been no recurrences to date. Our results showed that thoracoscopic loop ligation is safe and effective in managing blebs and parenchymal bullae, with a lower cost, fewer complications, and a lower recurrence rate than provided by standard surgical techniques. On the basis of our results, we advocate the use of the self-made endoscopic loop for ligation of parenchymal blebs and bulla in patients with spontaneous pneumothorax to achieve a truly cost-effective and minimally invasive thoracoscopic procedure. (J Thorac Cardiocasc Surg 1997:113:50-4)

This article has been cited by other articles:

				J-M. Tschopp, C. Boutin, P. Astoul, J-P. Janssen, S. Grandin, C-T. Bolliger, L. Delaunois, P. Driesen, G. Tassi, A-P. Perruchoud, et al. Talcage by medical thoracoscopy for primary spontaneous pneumothorax is more cost-effective than drainage: a randomised study Eur. Respir. J., October 1, 2002; 20(4): 1003 - 1009. [Abstract] [Full Text] [PDF]

				N. Sawabata, M. Ikeda, A. Matsumura, H. Maeda, S. Miyoshi, and H. Matsuda New Electroablation Technique Following the First-Line Stapling Method for Thoracoscopic Treatment of Primary Spontaneous Pneumothorax Chest, January 1, 2002; 121(1): 251 - 255. [Abstract] [Full Text] [PDF]

				J.-P. Fossard, A. Samet, C. Meistelman, and D. Longrois Life-threatening pneumothorax of the ventilated lung during thoracoscopic pleurectomy Can J Anesth, May 1, 2001; 48(5): 493 - 496. [Abstract] [Full Text] [PDF]