The treatment of recurrent spontaneous pneumothorax is either by VATS with pleurodesis, chemical pleurodesis, or thoracotomy. Few reports have described pleuroscopy with talc pleurodesis for recurrent pneumothorax. We describe our experience using pleuroscopy for talc pleurodesis of recurrent spontaneous pneumothorax.
Pleuroscopy was done with conscious sedation (Midazolam + fentanyl) and local anaesthesia. Using a single port technique, the Olympus semirigid pleuroscope was used to inspect the pleura, and take biopsies of suspicious areas. 4 grams of Steritalc (Novatech Corporation Aubagne, France) in the form of a slurry was then sprayed under vision over the parietal and visceral surfaces. Post procedure, the chest tube was attached to 20–30 cm H2O suction for the first 48 hrs. Suction was then removed, and the chest tube removed once the drainage was less than 50 cc over 24 hours. Immediate and long term success rates (defined as complete lung expansion with no recurrence of pneumothorax), complications, duration of drainage, and length of stay were studied.
The study included 8 patients, 6 males and 2 females, with age distribution shown in Table 1. The etiology of pneumothorax was subpleural blebs in 7 cases, and tuberculous plaques were found in one patient. The median duration of chest tube drainage was 3 days and length of stay was 5 days. No significant complications were noted. Immediate success rates were 100%. Long term success rate (mean follow up of 4 months) was 88%, with one recurrence at 6 months, which was pleurodesed again. The average cost of procedure was $1100 in the Indian setting.
Pleuroscopic talc pleurodesis under local anesthesia and conscious sedation is a safe, effective and economical treatment for recurrent spontaneous pneumothorax. It also permits early discharge and return to normal activity.
This procedure can be done by pulmonologists, is more effective than chest tube chemical pleurodesis, and has results comparable to VATS pleurodesis. Additional investigation is warranted to define its place in the approach to recurrent pneumothorax.
Ravindra Mehta, No Financial Disclosure Information; No Product/Research Disclosure Information