To describe our recent experience with a ‘cape’ method that uses a bioabsorbable polyglycolic acid (PGA) sheet to reduce air leaks and prevent postoperative recurrences of spontaneous pneumothorax.
From February 2008 to March 2008, during VATS in three patients with SP, we used a new cape method that employs a PGA sheet for stapler-line reinforcement. There were 2 men and 1 woman. All patients were 17 years of age. The operation sites were the right lung in 1 patient and the left lung in 2. All had emphysematous bullae in the apex of the affected lung. An automatic stapler, the GIA Universal 60-mm linear stapling device (U.S. Surgical Corp. Norwalk, CT, USA), was used with a PGA sheet. A 5 mm cut was made in the center of the PGA sheet, which was then guided over the apical bulla with lung forceps. The bulla was pulled through the cut hole with the lung foreceps, and the diseased lung tissue was resected by stapling across the PGA sheet. After firing the stapler, we performed a sealing test by inflating the lung under 15cm of water pressure to detect persistent air leaks.
No immediate air leak was obsereved after stapling in 3 (100%) of 3 cases. In every patient, a chest tube was left in place for 2 days. None of the patients had a postoperative recurrence of pneumothorax or empyema during the postoperative follow-up period.
To our knowledge this is the first report of a bioabsorbable cape method for the prevention of persistent air leaks and recurrence in patients with spontaneous pneumothorax undergoing video-assisted thoracoscopic surgery. Although further investigation is necessary to confirm the feasibility and clinical utility of this approach, we feel it is a promising technique for the prevention of air leaks and postoperative pneumothorax after VATS in patients with spontaneous pneumothorax.
Althoug more clinical experience should be required, bioabsorbable cape method might be useful technique for prevention of postoperative recurrence of spontaneous pneumothorax.
Tomohito Saito, No Financial Disclosure Information; No Product/Research Disclosure Information