# Spontaneous Pneumothorax — GCMD Library living collection

Updated: n/a · 8 episodes · 132 cited statements

## Episodes
### Resources
- [Supine Positioning for Bilateral VATS: Pediatric Surgery Difficult...](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432) — video · 15:50 · [machine version](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432.md)
- [Tricks - Supine Positioning For Bilateral VATS](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638) — video · 17:04 · [machine version](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638.md)
- [Update Course Rewind 2021 - Updates in Pectus](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411) — video · 1:01:14 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411.md)
- [Spontaneous Pneumothorax Rapid Fire: Update Course 2015](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986) — video · 9:45 · [machine version](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986.md)
- [Spontaneous Pneumothorax: Update Course 2014](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044) — video · 15:59 · [machine version](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044.md)
- [Spontaneous Pneumothorax](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521) — podcast · 33:31 · [machine version](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521.md)
- [Thoracoscopic Treatment of Spontaneous Pneumothorax](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233) — video · 3:16 · [machine version](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233.md)
- [Thoracoscopic Treatment of Spontaneous Pneumothorax](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249) — video · 3:16 · [machine version](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249.md)

## Chapters
- [0:03](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=3) Case Presentation: Bilateral VATS in Supine Position (Ep 1)
- [4:07](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=247) Patient Selection and Indications for Supine Bilateral VATS (Ep 1)
- [7:14](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=434) Technical Considerations: Positioning and Lung Collapse (Ep 1)
- [10:04](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=604) Pleurodesis Techniques and Necessity Debate (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=0) Case Presentation: Bilateral Supine VATS for Spontaneous Pneumothorax (Ep 2)
- [5:20](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=320) Indications and Patient Selection for Supine VATS (Ep 2)
- [9:15](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=555) Technical Details: Double-Lumen Intubation and Exposure (Ep 2)
- [11:28](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=688) Pleurodesis Techniques: Mechanical, Chemical, and Pleurectomy Debate (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=0) Initial management of large spontaneous pneumothorax and the thoracentesis-only approach (Ep 4)
- [3:21](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=201) Contralateral blebs: to scan and operate prophylactically or not (Ep 4)
- [6:00](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=360) Surgical technique: pleurodesis versus bleb resection alone (Ep 4)
- [0:00](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=0) Intraparenchymal disease mimicking effusion: diagnostic pitfalls (Ep 5)
- [1:33](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=93) Small pneumothorax management: observation vs. aspiration vs. chest tube (Ep 5)
- [7:23](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=443) Large pneumothorax and bilateral blebs: timing of intervention (Ep 5)
- [10:50](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=650) VATS technique: bleb resection and pleurodesis controversies (Ep 5)
- [0:00](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=0) Introduction and Case Presentation (Ep 6)
- [3:05](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=185) Retrospective Data on Chest Tube Outcomes (Ep 6)
- [8:59](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=539) Aspiration Protocol and Study Design (Ep 6)
- [14:22](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=862) Aspiration Study Results (Ep 6)
- [19:38](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1178) Clinical Application and Family Counseling (Ep 6)
- [23:27](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1407) Pleurodesis Evidence (Ep 6)
- [26:05](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1565) Role of CT Imaging (Ep 6)
- [27:31](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1651) Management of Recurrent Cases (Ep 6)
- [31:38](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1898) Future Directions and Closing (Ep 6)
- [0:03](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=3) Case presentation and patient positioning (Ep 7)
- [1:16](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=76) Talc preparation technique (Ep 7)
- [1:53](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=113) Bleb resection with endo-GIA stapler (Ep 7)
- [2:34](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=154) Talc pleurodesis and closure (Ep 7)
- [0:03](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=3) Case presentation and patient positioning (Ep 8)
- [1:16](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=76) Talc preparation technique (Ep 8)
- [1:53](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=113) Bleb resection with endo-GIA stapler (Ep 8)
- [2:34](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=154) Talc pleurodesis and closure (Ep 8)
- [0:00](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=0) Introduction and Initial Polling on Pain Control (Ep 3)
- [2:37](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=157) Cryoanalgesia Advocacy and Evidence (Ep 3)
- [9:33](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=573) Skepticism About Cryoanalgesia Long-term Safety (Ep 3)
- [17:13](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1033) Cryoanalgesia Rebuttal and Registry Discussion (Ep 3)
- [20:41](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1241) ERAS Protocol as Alternative to Regional Anesthesia (Ep 3)
- [25:56](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1556) Epidural Catheter Discussion and Erector Spinae Catheters (Ep 3)
- [31:37](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1897) Activity Restrictions and Bar Flippage (Ep 3)
- [35:21](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2121) Bar Length Selection and Shorter Bar Technique (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- In a randomized trial of 110 patients comparing epidural to PCA, maximum pain scores did not drop off in the epidural group due to day 2-3 transition pain, whereas PCA group pain decreased over 4.5 days. — Shawn St. Peter (clinical) [Ep 3 · 3:27](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=207)
- Cryotherapy technique involves freezing ribs 4 through 7 for two minutes per rib; should not go to rib 8 or below due to risk of abdominal wall paralysis. — Shawn St. Peter (clinical) [Ep 3 · 6:20](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=380)
- In prospective observational cryoanalgesia study, six of nine patients in initial retrospective cohort went home on post-op day one. — Shawn St. Peter (clinical) [Ep 3 · 7:20](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=440)
- With cryoanalgesia, length of stay that couldn't get below four days became one day, with tight range except for occasional failures that look like traditional four-day stays. — Shawn St. Peter (clinical) [Ep 3 · 7:55](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=475)
- Median morphine equivalents with cryoanalgesia versus traditional approaches are not on the same planet in terms of magnitude of difference. — Shawn St. Peter (clinical) [Ep 3 · 8:30](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=510)
- Medical devices and implants are not required to undergo clinical trials before market introduction, unlike drugs. — Victor Garcia (guideline) [Ep 3 · 10:40](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=640)
- Cryotherapy devices received FDA approval via 510(k) predicate pathway based on similarity to devices from 1976, not based on clinical trials. — Victor Garcia (guideline) [Ep 3 · 14:10](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=850)
- With erector spinae catheters, hospital stay is two days with reduced opioid requirements both in-hospital and post-discharge. — Victor Garcia (clinical) [Ep 3 · 28:20](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1700)
- When bars flip, it is always technical - related to bar sitting in funky inner space, bad spot, not wrapped tight enough, or not secured well - not related to patient activity or pain modality. — Shawn St. Peter (opinion) [Ep 3 · 30:50](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1850)
- Activity restrictions beyond two weeks post-Nuss can be liberalized to anything the patient can handle, including bull riding, boxing, football, and hockey. — Shawn St. Peter (clinical) [Ep 3 · 29:24](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1764)
- Adult experience using cryotherapy with thoracotomies goes back 20 years without high enough incidence of complications to warrant backing away from the treatment advantage. — Shawn St. Peter (epidemiological) [Ep 3 · 19:00](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1140)
- With cryoanalgesia, 70% of patients go home on post-op day one without narcotics. — Steven Rothenberg (clinical) [Ep 3 · 34:00](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2040)
- Sternal elevator is used in about 10% of cases, primarily in older males with deep, stiff pectus where flexibility is limited. — Steven Rothenberg (clinical) [Ep 3 · 45:50](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2750)
- In updated series of 554 patients, bar rotation rate was 0.7%, with most occurring within first few years of surgeon experience. — Shawn St. Peter (epidemiological) [Ep 3 · 39:16](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2356)
- Sub-xiphoid dissection technique allows palpation-guided bar passage and has resulted in 0% incidence of pericarditis. — Shawn St. Peter (clinical) [Ep 3 · 43:20](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2600)
- Many patients have normal anterior chest sensation even in early post-op phase (two to three weeks) after cryoanalgesia, suggesting nerve stunning rather than complete death. — Shawn St. Peter (clinical) [Ep 3 · 18:20](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1100)
- Gabapentin is most commonly given once pre-op then 200-300mg three times daily for up to one week post-op; pharmacokinetics suggest starting several days before operation for peak effect. — Justin Wagner (clinical) [Ep 3 · 22:40](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1360)
- When passing bar from left chest to right chest, the angle avoids pointing directly at the ventricle compared to right-to-left passage. (clinical) [Ep 3 · 41:20](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2480)
- In 15-patient magnetic repair trial, magnets were safe to place in children's chests and well-tolerated, but results were not as effective as hoped; appears most effective in young children with flexible chests. — Shawn St. Peter (clinical) [Ep 3 · 59:24](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=3564)
- Patient selection for supine bilateral VATS should include procedures with low morbidity and very well-defined pathology such that you won't encounter any surprises. — Nick (opinion) [Ep 1 · 4:54](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=294)
- Bilateral thoracic sympathectomies for hyperhidrosis can be performed in supine position at one sitting. — Jose (clinical) [Ep 1 · 5:15](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=315)
- For sympathectomy in supine position, the lung falls away adequately with table tipping and CO2 compression of the lung to help with exposure. — Jose (clinical) [Ep 1 · 6:04](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=364)
- Supine VATS is useful in low-risk to conversion thoracoscopic cases and applicable for low-risk pleural-based lesion cases, superficial wedge resections, or biopsies. — Mark McCollum (opinion) [Ep 1 · 6:41](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=401)
- If there's a high risk of conversion or difficulty with exposure, traditional decubitus position is preferred over supine. — Mark McCollum (opinion) [Ep 1 · 7:14](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=434)
- Bilateral phrenic nerve stimulators for patients with central hyperventilation syndrome is a good candidate for supine bilateral VATS because the phrenic nerve is quite anterior. — Sharif (clinical) [Ep 1 · 8:00](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=480)
- A double-lumen tube was used with positive pressure in the chest being worked on, providing great exposure. — Mark McCollum (clinical) [Ep 1 · 9:09](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=549)
- Mechanical pleurodesis was performed from about the 5th rib intercostal space up to the apex, circumferentially, and was as easy as the standard decubitus approach. — Mark McCollum (clinical) [Ep 1 · 9:09](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=549)
- Parietal pleurectomy is fairly easy once you get into the space underneath the parietal pleura and is a far more effective way to seal the pleural cavity than mechanical pleurodesis. — Jack (opinion) [Ep 1 · 10:13](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=613)
- Recurrences have been seen after mechanical pleurodesis, but no recurrences have occurred after pleurectomy in one surgeon's experience. — Jack (clinical) [Ep 1 · 10:40](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=640)
- Blood patch technique is very effective for pleurodesis, and blood should not be suctioned out during the procedure. — Jack (clinical) [Ep 1 · 10:57](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=657)
- Blebs are not just a one-point-in-time thing but relate to lung anatomy and overstretch, so removing one bleb does not prevent another from forming in a few months. — Jack (opinion) [Ep 1 · 11:43](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=703)
- Blebs are congenital and do not form over time at age 16; they become problematic during growth in the preteens. — Sharif (opinion) [Ep 1 · 11:55](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=715)
- In certain congenital problems, blebs can be present all over the chest, with the largest ones at the apex assumed to be the ones that burst, but blebs may exist that cannot be seen or identified. — Kathy (clinical) [Ep 1 · 12:22](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=742)
- Pleurectomy and talc pleurodesis are very painful postoperatively, and re-operating in a chest that has had talc is extremely difficult due to the entire lung being frozen. — Mark McCollum (clinical) [Ep 1 · 14:17](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=857)
- Mechanical pleurodesis works effectively by causing only the apex of the lung to adhere, which may be sufficient to prevent tension pneumothorax without freezing the entire chest. — Mark McCollum (opinion) [Ep 1 · 14:45](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=885)
- In the presented case, the area where the previous bleb had spontaneously erupted was well adhered to the apex of the chest when the right side was started. — Mark McCollum (clinical) [Ep 1 · 14:45](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=885)
- Parietal pleurectomy, once started, is hard to stop because it strips away easily, and postoperative pain is manageable with modern analgesics. — Jack (clinical) [Ep 1 · 15:14](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=914)
- Lateral decubitus positioning has been adopted from the transition from open thoracotomy to VATS and provides ease of exposure and rapid conversion to open thoracotomy, but with advancements in VATS this no longer applies. — Nick Bruns (opinion) [Ep 2 · 0:45](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=45)
- Lateral positioning may add unnecessary morbidity including brachial plexus injury and decubitus ulcers. — Nick Bruns (clinical) [Ep 2 · 1:30](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=90)
- The patient is a 17-year-old male with history of asthma who presented with shortness of breath and chest tightness when running, found to have bilateral apical blebs and a large right spontaneous pneumothorax treated with chest tube, later developing a small left spontaneous pneumothorax that resolved with observation. — Nick Bruns (clinical) [Ep 2 · 1:40](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=100)
- Bilateral VATS with bilateral apical bleb resections and mechanical pleurodesis was performed in the supine position due to the routine nature of the procedure. — Nick Bruns (clinical) [Ep 2 · 2:20](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=140)
- Port placement for supine VATS included 25mm ports at the 7th intercostal space midclavicular line and 6th intercostal space mid-axillary line, plus a 12mm port at the 4th intercostal space mid-axillary line to accommodate the GIA stapler. — Nick Bruns (clinical) [Ep 2 · 2:40](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=160)
- Bilateral VATS was safely completed in the supine position, providing simplicity, convenience, decreased operative time, and decreased positioning-related morbidity. — Nick Bruns (opinion) [Ep 2 · 4:40](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=280)
- Patient selection for supine VATS is important; appropriate cases include bilateral VATS with low morbidity and well-defined pathology where you won't encounter surprises. — Nick Bruns (clinical) [Ep 2 · 6:09](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=369)
- Bilateral thoracic sympathectomies for hyperhidrosis can be performed in the supine position at one sitting. — Jose (clinical) [Ep 2 · 6:30](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=390)
- For sympathectomy in supine position, the lung falls away adequately with table tipping and CO2 compression of the lung to help with exposure. — Jose (clinical) [Ep 2 · 7:19](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=439)
- Supine VATS is useful in low-risk-to-conversion thoracoscopic cases; any low-risk pleural-based lesion case for biopsy or superficial wedge resection would be applicable, but if there's high risk of conversion or difficulty with exposure, traditional decubitus positioning is preferred. — Mark McCollum (clinical) [Ep 2 · 7:58](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=478)
- Bilateral phrenic nerve stimulators for patients with central hyperventilation syndrome can be placed in supine position because the phrenic nerve is quite anterior. — Sharif (clinical) [Ep 2 · 9:15](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=555)
- In the presented case, a double-lumen tube was used with positive pressure in the chest being worked on, providing great exposure. — Mark McCollum (clinical) [Ep 2 · 10:34](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=634)
- Mechanical pleurodesis was performed circumferentially from about the 5th intercostal space up to the apex, which was as easy as the standard approach with decubitus positioning. — Mark McCollum (clinical) [Ep 2 · 10:34](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=634)
- The patient was moved to the side edge of the bed to allow full mobility of the surgeons' hands. — Mark McCollum (clinical) [Ep 2 · 10:34](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=634)
- Parietal pleurectomy is fairly easy—you get into the space underneath the parietal pleura and strip it off—and is a far more effective way to seal the pleural cavity than mechanical pleurodesis. — Jeff Blair (opinion) [Ep 2 · 11:28](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=688)
- There have been recurrences after mechanical pleurodesis, but no recurrences after pleurectomy in the speaker's experience. — Jeff Blair (clinical) [Ep 2 · 11:28](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=688)
- The blood patch technique is very effective for pleurodesis, and you don't want to suction out any blood for this reason. — Jack (clinical) [Ep 2 · 12:12](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=732)
- Pleurodesis may not be necessary in these cases because the cause of the problem is blebs in the apex of the lung; removing the blebs should prevent recurrent pneumothorax. — Jack (opinion) [Ep 2 · 12:40](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=760)
- Blebs are not just a one-point-in-time thing; they have to do with the anatomy of the lung and overstretch, so if you take out one bleb, another bleb could form in a few months. — Jack (opinion) [Ep 2 · 12:57](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=777)
- These are congenital blebs that don't form over time at age 16. — Jack (opinion) [Ep 2 · 13:10](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=790)
- There are certain congenital problems where you go in and there are blebs all over the place; you see the largest ones at the apex and assume those burst, but you can have blebs you can't see or identify. — Cathy (clinical) [Ep 2 · 13:35](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=815)
- The speaker strips the cupola of the pleura and uses the abrading technique for the lower aspects of the chest where stripping becomes harder. — Cathy (clinical) [Ep 2 · 13:35](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=815)
- Pleurectomy is incredibly painful postoperatively. — Jeff Blair (clinical) [Ep 2 · 14:34](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=874)
- Patients who received talc pleurodesis had more pain postoperatively compared to mechanical pleurodesis, based on anecdotal observation. — Sharif (clinical) [Ep 2 · 15:05](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=905)
- Pleurectomy and talc are very painful postoperatively, and if you've ever had to re-operate in a chest that's had talc in it, you'll never do it again because the whole lung becomes frozen. — Mark McCollum (clinical) [Ep 2 · 15:32](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=932)
- Mechanical pleurodesis works effectively because you just need the apex of the lung to stick up, not the whole lung frozen. — Mark McCollum (opinion) [Ep 2 · 15:32](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=932)
- In the presented case, when starting on the right side, the area where the previous bleb had spontaneously erupted was well adhered to the apex of the chest. — Mark McCollum (clinical) [Ep 2 · 15:32](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=932)
- The more painful the pleurodesis, probably the more effective it is. — Jack (opinion) [Ep 2 · 16:01](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=961)
- Once you start pleurectomy, it's hard to stop because it strips away easily, and with modern analgesics the pain is manageable. — Jeff Blair (clinical) [Ep 2 · 16:29](https://library.globalcastmd.com/watch/tricks-supine-positioning-for-bilateral-vats-638?t=989)
- A 50% pneumothorax collapse actually represents 100% collapse because the lung cannot disappear. (clinical) [Ep 4 · 0:41](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=41)
- One approach is to put in a chest drain, aspirate the air, remove the tube, get an X-ray after 6 hours, and discharge the patient home from the ER without admission. (clinical) [Ep 4 · 1:59](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=119)
- The recurrence rate after initial pneumothorax treatment is quoted as 30%. (epidemiological) [Ep 4 · 3:42](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=222)
- In adult literature, the data does not support high rates of contralateral pneumothorax. (epidemiological) [Ep 4 · 4:50](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=290)
- One approach is to obtain CT scan preoperatively, and if blebs are present bilaterally, offer bilateral VATS with pleurodesis at the same operation. (clinical) [Ep 4 · 4:50](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=290)
- Pleurectomy causes severe postoperative pain, with patients 'climbing out of the hospital.' (clinical) [Ep 4 · 6:02](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=362)
- Pleurodesis causes significant postoperative pain. (clinical) [Ep 4 · 8:23](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=503)
- Ultrasound can sometimes be misleading in distinguishing pleural effusion from intraparenchymal disease, requiring trust in ultrasound technician skill and correlation with CT when findings are discordant. (clinical) [Ep 5 · 0:00](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=0)
- Intraparenchymal necrotic lung disease may require surgery a week or two later when the lung falls apart and develops an effusion and fistula. (clinical) [Ep 5 · 1:25](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=85)
- For a 5-10% apical pneumothorax in a minimally symptomatic patient, observation with oxygen is appropriate initial management. (clinical) [Ep 5 · 2:12](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=132)
- There is debate about whether oxygen therapy for pneumothorax actually works, though it is commonly used. (opinion) [Ep 5 · 2:16](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=136)
- Simple aspiration of small pneumothorax may cause more trouble and result in a bigger pneumothorax. (clinical) [Ep 5 · 2:40](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=160)
- Many pneumothorax patients never show an air leak after chest tube placement. (clinical) [Ep 5 · 3:15](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=195)
- If simple aspiration is performed, leaving a catheter overnight may prevent the need for two procedures in patients who fail aspiration. (clinical) [Ep 5 · 3:47](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=227)
- Needle aspiration of a small apical pneumothorax may result in a larger pneumothorax. (clinical) [Ep 5 · 3:55](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=235)
- Simple aspiration is not well studied in children under 16 years old due to the rarity of spontaneous pneumothorax in this age group. (epidemiological) [Ep 5 · 6:50](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=410)
- Patients with spontaneous pneumothorax typically have a very asthenic, thin chest configuration on X-ray. (clinical) [Ep 5 · 7:23](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=443)
- Every spontaneous pneumothorax patient has blebs in the upper part of the lung. (clinical) [Ep 5 · 7:23](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=443)
- CT is obtained to evaluate the contralateral side for blebs, which informs counseling about future risk and may guide decision for prophylactic intervention. (clinical) [Ep 5 · 7:38](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=458)
- If CT shows contralateral blebs, a future pneumothorax on that side can be treated directly with VATS without wasting time on chest tube placement. (clinical) [Ep 5 · 8:44](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=524)
- Before the era of VATS, the rule was to wait for a second pneumothorax before performing thoracotomy for bleb resection and pleural abrasion. (clinical) [Ep 5 · 9:11](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=551)
- In the current era, the paradigm has shifted to more aggressive intervention with primary VATS on first pneumothorax presentation. (clinical) [Ep 5 · 9:38](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=578)
- Prophylactic contralateral intervention may be justified in select cases such as patients planning extended remote travel (e.g., 2 months hiking in backcountry). (clinical) [Ep 5 · 9:46](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=586)
- Standard VATS technique for pneumothorax includes apical wedge resection and roughing up the pleura. (clinical) [Ep 5 · 10:58](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=658)
- If the patient has had multiple chest tubes previously, talc pleurodesis should be considered in addition to bleb resection and pleural abrasion. (clinical) [Ep 5 · 10:58](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=658)
- Talc applied thoracoscopically distributes beautifully throughout the pleural space. (clinical) [Ep 5 · 11:30](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=690)
- Mechanical abrasion of both visceral and parietal pleura improves outcomes, though aggressive visceral pleural abrasion can cause air leaks. (clinical) [Ep 5 · 11:52](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=712)
- On re-operation, chests that had previous pleural roughing may appear as if no prior surgery was performed. (clinical) [Ep 5 · 12:02](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=722)
- If all visible blebs are resected, pleurodesis may not be necessary. (opinion) [Ep 5 · 12:19](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=739)
- Re-entering a chest that has had talc pleurodesis is extremely difficult and may require pleural decortication. (clinical) [Ep 5 · 15:27](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=927)
- Mechanical pleurodesis should be limited to the apex (4th intercostal space and above) rather than the entire chest. (clinical) [Ep 5 · 12:42](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=762)
- Adequate mechanical pleurodesis is achieved when small blood vessels become prominent on the pleura. (clinical) [Ep 5 · 12:54](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=774)
- Deflating and reinflating the lung multiple times during surgery helps identify blebs, particularly on the edges of the lower lobe. (clinical) [Ep 5 · 13:46](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=826)
- Blebs can be sealed with energy devices rather than stapled, allowing surgery through 3 or 5 millimeter incisions. (clinical) [Ep 5 · 13:55](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=835)
- A study of 350 patients who underwent lung procedures without postoperative chest tube placement showed no complications. (epidemiological) [Ep 5 · 14:17](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=857)
- The no-chest-tube study included lung biopsies, not spontaneous pneumothorax patients. (epidemiological) [Ep 5 · 14:30](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=870)
- Omitting chest tubes after pneumothorax surgery requires reliable nursing care to detect early postoperative pneumothorax, which may not be available in all settings. (clinical) [Ep 5 · 14:49](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=889)
- Primary spontaneous pneumothorax is more common in males by approximately 3 to 1 ratio — Dan Osley (epidemiological) [Ep 6 · 1:42](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=102)
- CT scan data fairly convincingly shows that it is probably not beneficial with regard to changing treatment parameters or outcomes for spontaneous pneumothorax — Dan Osley (clinical) [Ep 6 · 3:05](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=185)
- In multi-institutional retrospective trial, chest tubes worked about 50% of the time for spontaneous pneumothorax — Dan Osley (clinical) [Ep 6 · 3:32](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=212)
- The failure rate for patients who get a chest tube and resolve is about 50% - they will be back and have to have another operation — Dan Osley (clinical) [Ep 6 · 5:00](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=300)
- Patients who get a chest tube and fail in the hospital and subsequently go on to VATS still have a failure rate of around 25 to 30% — Dan Osley (clinical) [Ep 6 · 5:24](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=324)
- Patients who get immediate VATS have about a 10 to 15% failure rate — Dan Osley (clinical) [Ep 6 · 8:02](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=482)
- Patients who get a chest tube and then VATS have higher failure rates (25%) than those who get immediate VATS, possibly because they are predisposed to recurrence — Dan Osley (clinical) [Ep 6 · 8:23](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=503)
- The Society of Thoracic Surgery in adult patients recommends primary aspiration for spontaneous pneumothorax — Dan Osley (guideline) [Ep 6 · 9:49](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=589)
- In most large studies for primary spontaneous pneumothorax, the mean age is around 20 to 22 years, making this primarily a young adult disease — Dan Osley (epidemiological) [Ep 6 · 9:49](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=589)
- The average age in pediatric spontaneous pneumothorax studies has been between 15.5 and 16 years — Dan Osley (epidemiological) [Ep 6 · 9:49](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=589)
- The hole in spontaneous pneumothorax has probably already closed by the time patients come to the hospital — Todd Ponsky (clinical) [Ep 6 · 10:27](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=627)
- There is no published paper documenting tension physiology for spontaneous pneumothorax — Todd Ponsky (clinical) [Ep 6 · 11:07](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=667)
- Of 81 patients in retrospective study across 3 institutions over 13 years, none presented with tension physiology from spontaneous pneumothorax — Dan Osley (clinical) [Ep 6 · 11:40](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=700)
- In Midwest Consortium prospective study, 50% of patients who got aspiration failed within 6 hours — Dan Osley (clinical) [Ep 6 · 14:22](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=862)
- In the aspiration study, 33 patients presented across 9 institutions over 2 years — Dan Osley (epidemiological) [Ep 6 · 14:39](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=879)
- Of 17 patients who failed aspiration, 12 received chest tubes and 83% of those had persistent air leak requiring VATS or had recurrent pneumothorax — Dan Osley (clinical) [Ep 6 · 15:50](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=950)
- Of 5 patients who went directly to VATS after failed aspiration, none recurred — Dan Osley (clinical) [Ep 6 · 16:38](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=998)
- Of 16 patients who passed aspiration and went home, 40% came back with recurrent pneumothorax — Dan Osley (clinical) [Ep 6 · 18:27](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1107)
- The positive predictive value of aspiration in treating pneumothorax was 83% with negative predictive value of 56% — Dan Osley (clinical) [Ep 6 · 18:39](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1119)
- There is good data suggesting that pleurodesis is not beneficial in preventing recurrence of spontaneous pneumothorax — Dan Osley (clinical) [Ep 6 · 23:27](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1407)
- In three-institution retrospective data, patients who underwent VATS with pleurodesis had the same recurrence rate as those who underwent VATS alone — Dan Osley (clinical) [Ep 6 · 23:48](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1428)
- A large Chinese trial of 289 patients over 3 years (average age 22) randomized patients to wedge resection with or without mechanical pleurodesis using standardized sandpaper abrasion and showed identical recurrence rates — Dan Osley (clinical) [Ep 6 · 24:20](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1460)
- Chemical pleurodesis with talc is probably more effective than mechanical pleurodesis but creates a treacherous reoperative field — Todd Ponsky (opinion) [Ep 6 · 25:13](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1513)
- CT scans may identify blebs that are incidental findings in patients who never develop pneumothorax, similar to traumatic pneumatoceles that rarely rupture — Dan Osley (clinical) [Ep 6 · 26:30](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1590)
- For patients with multiple recurrences after VATS, thoracoscopic pleurectomy of parietal pleura from apex down to a couple ribs above diaphragm is performed — Dan Osley (clinical) [Ep 6 · 27:31](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1651)
- Pleurectomy is an arduous, bloody operation that is super painful for children, usually requiring epidurals, with patients hospitalized for a week or 10 days — Dan Osley (clinical) [Ep 6 · 27:31](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1651)
- For recurrent recurrent pneumothorax cases, talc pleurodesis would be used if available because it is an appropriate population where preventing reoperation is critical — Dan Osley (opinion) [Ep 6 · 28:51](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1731)
- Aerosolized talc comes in a can with a straw, is inserted down the trocar site, and when sprayed looks like it is snowing inside the chest — Todd Ponsky (clinical) [Ep 6 · 29:31](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1771)
- For small apical pneumothorax after pleurodesis where lung is fixed to chest wall and patient is asymptomatic, observation with repeat chest X-ray in 48 hours is appropriate rather than operation — Dan Osley (clinical) [Ep 6 · 30:15](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-1521?t=1815)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- In Texas Children's study, 50% of patients still take opioids two weeks after Nuss procedure. — Justin Wagner summarizing the discussion [Ep 3 · 24:10](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1450)
- In past five years, hospital length of stay for Nuss procedures has been cut in half through protocol improvements. — Justin Wagner summarizing the discussion [Ep 3 · 24:40](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1480)
- In Nebraska protocol without epidurals, catheters, or cryo, length of stay is under two days and patients are off opioids by one week. — Justin Wagner summarizing the discussion [Ep 3 · 25:20](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1520)
- In Texas Children's study, urinary retention was 8% in cryo group versus 34% in non-cryo group. — Justin Wagner summarizing the discussion [Ep 3 · 26:00](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1560)
- Bar flippage occurs almost eight times more commonly in cryo group, and allodynia/neuropathy occurs about six times more frequently in cryo group. — Justin Wagner summarizing the discussion [Ep 3 · 26:25](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1585)
- In randomized epidural trial, epidural could either not be placed or was removed after one day in approximately 25% of patients. — Whit summarizing the discussion [Ep 3 · 26:55](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=1615)
- Pilegaard technique uses shorter bars placed asymmetrically with right side covering two rib spaces and left side with single stabilizer, resulting in well below 1% bar flip rate. — Justin Wagner summarizing the discussion [Ep 3 · 37:19](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2239)
- Computational modeling shows flatter bars focus stress on sternum while bigger curved bars have parasitic forces causing unwanted horizontal and torque action at bar ends. — Justin Wagner summarizing the discussion [Ep 3 · 38:10](https://library.globalcastmd.com/watch/update-course-rewind-2021-updates-in-pectus-5411?t=2290)
- Lateral decubitus positioning was adopted from the transition from open thoracotomy to VATS but may add unnecessary morbidity including brachial plexus injury and decubitus ulcers. — The host summarizing the discussion [Ep 1 · 0:03](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=3)
- The presented case involved a 17-year-old male with asthma presenting with shortness of breath and chest tightness when running, found to have bilateral apical blebs and a large right spontaneous pneumothorax treated with chest tube, followed by a small left spontaneous pneumothorax that resolved with observation. — The host summarizing the discussion [Ep 1 · 0:30](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=30)
- Bilateral VATS with bilateral apical bleb resections and mechanical pleurodesis was performed in supine position with single sterile preparation, reducing operative time. — The host summarizing the discussion [Ep 1 · 1:30](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=90)
- Port placement for the right side included 25mm ports at the 7th intercostal space midclavicular line and 6th intercostal space mid-axillary line, plus a 12mm port at the 4th intercostal space mid-axillary line to accommodate the GIA stapler. — The host summarizing the discussion [Ep 1 · 2:00](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=120)
- Pleurodesis may not be necessary after bleb resection because the cause of pneumothorax is blebs in the apex of the lung, and removing the blebs should prevent recurrent pneumothorax. — Todd Ponsky summarizing the discussion [Ep 1 · 11:25](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=685)
- A prospective randomized trial comparing blebectomy with pleurodesis versus blebectomy without pleurodesis could determine if there is a higher incidence of recurrence without pleurodesis. — Todd Ponsky summarizing the discussion [Ep 1 · 12:59](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=779)
- Pleurectomy is incredibly painful postoperatively. — Todd Ponsky summarizing the discussion [Ep 1 · 13:34](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=814)
- Patients receiving talc pleurodesis had more postoperative pain compared to mechanical pleurodesis in one surgeon's anecdotal experience. — Todd Ponsky summarizing the discussion [Ep 1 · 13:52](https://library.globalcastmd.com/watch/supine-positioning-for-bilateral-vats-pediatric-surgery-difficult-432?t=832)
- Thoracentesis-only approach (needle aspiration without tube placement) has a surprisingly lower recurrence rate than chest tube placement in the literature. — The host summarizing the discussion [Ep 4 · 2:45](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=165)
- Talc pleurodesis creates adhesions that make subsequent operations extremely difficult, described as 'like cement.' — The host summarizing the discussion [Ep 4 · 6:02](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=362)
- A Korean study of 1400 patients across 11 hospitals randomized patients to bleb resection with fibrinogen glue on the staple line versus pleurodesis, showing no difference in recurrence rates. — The host summarizing the discussion [Ep 4 · 7:05](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=425)
- In the Korean study, at one-year follow-up the fibrinogen glue group had 5.8% recurrence versus 8% recurrence in the pleurodesis group. — The host summarizing the discussion [Ep 4 · 7:05](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=425)
- A Beijing study of 300 patients comparing pleurodesis versus no pleurodesis showed no difference in recurrence rates. — The host summarizing the discussion [Ep 4 · 7:51](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-rapid-fire-update-course-2015-986?t=471)
- There is a 50% chance of failure with chest tube alone for spontaneous pneumothorax. — The host summarizing the discussion [Ep 5 · 4:05](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=245)
- 85% of pneumothorax patients can avoid an operation, making primary VATS potentially unjustified for all first-time presentations. — The host summarizing the discussion [Ep 5 · 4:05](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=245)
- 2001 ACCP consensus guidelines stated there was no role for simple aspiration in pneumothorax. — The host summarizing a resource [Ep 5 · 4:30](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=270)
- British Thoracic Society 2010 guidelines recommend simple aspiration as first-line therapy for pneumothorax. — The host summarizing a resource [Ep 5 · 4:30](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=270)
- A Cochrane review in 2007 found only one randomized controlled trial comparing manual aspiration versus chest tube for pneumothorax, which included patients as young as 16 years old. — The host summarizing a resource [Ep 5 · 5:10](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=310)
- The randomized trial showed an immediate success rate of aspiration of 59%, similar to chest tube success rates. — The host summarizing a resource [Ep 5 · 5:50](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=350)
- In the aspiration trial, there were 11 failures: 9 received chest tubes and only 2 went on to VATS, with 50% avoiding hospitalization and no difference in overall hospital stay or recurrence rate. — The host summarizing a resource [Ep 5 · 6:20](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=380)
- Every patient with spontaneous pneumothorax who has been evaluated in adult thoracic surgery has blebs on the top of the lung. — The host summarizing the discussion [Ep 5 · 7:10](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=430)
- In adult thoracic surgery practice, the paradigm is to fix the symptomatic side with blebs and observe the contralateral side with blebs, intervening only if a second pneumothorax develops. — The host summarizing the discussion [Ep 5 · 8:29](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=509)
- TissueSeal applied after roughing up pleural edges may promote adhesion, though it is more expensive than other methods. — The host summarizing the discussion [Ep 5 · 11:36](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-update-course-2014-1044?t=696)
- The patient is an 18 year old male who had sudden onset of right chest pain and dyspnea, leading to a diagnosis of right spontaneous pneumothorax on chest X-ray — The host summarizing a resource [Ep 7 · 0:03](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=3)
- The patient had undergone thoracoscopic treatment of a left spontaneous pneumothorax approximately 2 years earlier after failed non-operative management — The host summarizing a resource [Ep 7 · 0:42](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=42)
- A decision was made to proceed directly to surgical treatment of the right side without an attempt at catheter thoracostomy due to prior contralateral recurrence — The host summarizing a resource [Ep 7 · 0:58](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=58)
- The patient is placed in the lateral decubitus position with an axillary roll on a beanbag for thoracoscopic pneumothorax treatment — The host summarizing a resource [Ep 7 · 1:08](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=68)
- Three triangulating incisions are used: 2 for 5 millimeter ports, and a third, more anterior one for direct insertion of a 12 millimeter endo GIA stapler — The host summarizing a resource [Ep 7 · 1:16](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=76)
- A Lukens trap works well for thoracoscopic talc application: talc is placed in the trap, tubing is cut and attached to the spout, with one side attached to installation tubing and the other to a 5mm trocar — The host summarizing a resource [Ep 7 · 1:26](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=86)
- Several blebs were identified in the lung apex during full examination — The host summarizing a resource [Ep 7 · 1:53](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=113)
- The initial stapler firing did not capture an adequate margin under the blebs on the posterior surface — The host summarizing a resource [Ep 7 · 1:59](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=119)
- The stapler should be applied across a more generous margin of grossly normal lung tissue when initial margin is inadequate — The host summarizing a resource [Ep 7 · 2:08](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=128)
- Three firings of the stapler were necessary to completely remove the apical wedge in this case — The host summarizing a resource [Ep 7 · 2:17](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=137)
- The specimen can be removed directly through the largest chest wall incision — The host summarizing a resource [Ep 7 · 2:27](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=147)
- A pressure of 15 millimeters of mercury and a flow of 4 L per minute is used to insufflate the talc — The host summarizing a resource [Ep 7 · 2:34](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=154)
- It is important to keep the second trocar open in order to maintain a pressure differential and promote flow during talc insufflation — The host summarizing a resource [Ep 7 · 2:45](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=165)
- The tip of the trocar can be manipulated to distribute the talc widely — The host summarizing a resource [Ep 7 · 2:53](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=173)
- Adequate talc distribution results when a snowstorm effect is witnessed in the thoracic cavity — The host summarizing a resource [Ep 7 · 2:58](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=178)
- It is particularly important to confirm adequate coverage of the apical, visceral, and parietal pleura with talc — The host summarizing a resource [Ep 7 · 3:05](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=185)
- A 16 French chest tube is placed at the conclusion of the procedure — The host summarizing a resource [Ep 7 · 3:12](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=192)
- The patient is an 18 year old male who had sudden onset of right chest pain and dyspnea, leading to a diagnosis of right spontaneous pneumothorax on chest X-ray — The host summarizing a resource [Ep 8 · 0:03](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=3)
- The patient had undergone thoracoscopic treatment of a left spontaneous pneumothorax approximately 2 years earlier after failed non-operative management — The host summarizing a resource [Ep 8 · 0:42](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=42)
- A decision was made to proceed directly to surgical treatment of the right side without an attempt at catheter thoracostomy due to prior contralateral recurrence — The host summarizing a resource [Ep 8 · 0:58](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=58)
- The patient is placed in the lateral decubitus position with an axillary roll on a beanbag for thoracoscopic pneumothorax treatment — The host summarizing a resource [Ep 8 · 1:08](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=68)
- Three triangulating incisions are used: 2 for 5 millimeter ports, and a third, more anterior one for direct insertion of a 12 millimeter endo GIA stapler — The host summarizing a resource [Ep 8 · 1:16](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=76)
- A Lukens trap works well for thoracoscopic talc application: talc is placed in the trap, tubing is cut and attached to the spout, with one side attached to installation tubing and the other to a 5mm trocar — The host summarizing a resource [Ep 8 · 1:26](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=86)
- Several blebs were identified in the lung apex during full examination — The host summarizing a resource [Ep 8 · 1:53](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=113)
- The initial stapler firing did not capture an adequate margin under the blebs on the posterior surface — The host summarizing a resource [Ep 8 · 1:59](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=119)
- The stapler should be applied across a more generous margin of grossly normal lung tissue when initial margin is inadequate — The host summarizing a resource [Ep 8 · 2:08](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=128)
- Three firings of the stapler were necessary to completely remove the apical wedge in this case — The host summarizing a resource [Ep 8 · 2:17](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=137)
- The specimen can be removed directly through the largest chest wall incision — The host summarizing a resource [Ep 8 · 2:27](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=147)
- A pressure of 15 millimeters of mercury and a flow of 4 L per minute is used to insufflate the talc — The host summarizing a resource [Ep 8 · 2:34](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=154)
- It is important to keep the second trocar open in order to maintain a pressure differential and promote flow during talc insufflation — The host summarizing a resource [Ep 8 · 2:45](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=165)
- The tip of the trocar can be manipulated to distribute the talc widely — The host summarizing a resource [Ep 8 · 2:53](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=173)
- Adequate talc distribution results when a snowstorm effect is witnessed in the thoracic cavity — The host summarizing a resource [Ep 8 · 2:58](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=178)
- It is particularly important to confirm adequate coverage of the apical, visceral, and parietal pleura with talc — The host summarizing a resource [Ep 8 · 3:05](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=185)
- A 16 French chest tube is placed at the conclusion of the procedure — The host summarizing a resource [Ep 8 · 3:12](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2249?t=192)

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