This video appears in a new pediatric surgery textbook, Clinical Pediatric Surgery: A Case-Based Interactive Approach," by Dr. Sherif Emil. The book is an innovative educational resource that focuses on judgment and decision-making in pediatric surgery. If you’d like to learn more, watch this short video or read this short article.
Type: video · 3 min · posted 2020-02-24 Canonical: https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233 ## Chapters - [0:03](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=3) Case presentation and patient positioning - [1:16](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=76) Talc preparation technique - [1:53](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=113) Bleb resection with endo-GIA stapler - [2:34](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=154) Talc pleurodesis and closure ## Statements - "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" (clinical) [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" (clinical) [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" (clinical) [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" (clinical) [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" (clinical) [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" (clinical) [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" (clinical) [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" (clinical) [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" (clinical) [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" (clinical) [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" (clinical) [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" (clinical) [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" (clinical) [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" (clinical) [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" (clinical) [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" (clinical) [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" (clinical) [3:12](https://library.globalcastmd.com/watch/thoracoscopic-treatment-of-spontaneous-pneumothorax-2233?t=192) ## Transcript This video will demonstrate the therchoscopic treatment of spontaneous pneumothorax, namely bleb resection and chemical pleurodesis using talc powder. 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. He had undergone thochoscopic treatment of a left spontaneous pneumothorax approximately 2 years earlier after failed non-operative management. A decision was therefore made to proceed directly to surgical treatment of the right side without an attempt at catheter thoracostomy. This picture shows the positioning and incision sites used for the procedure in a different patient undergoing thoracoscopic treatment of left spontaneous pneumothorax. The patient is placed in the lateral decubitus position with an axillary roll on a beanbag. 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. Talc instufflation is used for the pleurodesis while commercial preparations for throchoscopic application of talc are available, the use of a Lucans strap works quite well. The talc is placed in the trap. A portion of the tubing is cut and attached to the spout on the trap. One side is then attached to the installation tubing, and the other to one of the 5 millimeter trocars. After full examination of the lung, several blebs are identified in the lung apex. The endo GIA is applied across the apex. However, one can see that the stapler did not capture an adequate margin under the blebs on the posterior surface. The apex is therefore retracted upwards, and the stapler is applied across a more generous margin of grossly normal lung tissue. The first firing of the stapler is insufficient for completing the wedge resection. Two more firings are therefore necessary to completely remove the apical wedge. The specimen is then removed directly through the largest chest wall incision. The talc installation is then started using the setup described earlier. A pressure of 15 millimeters of mercury, and a flow of 4 L per minute is used to insufflate the tal. It is important to keep the 2nd trocar open in order to maintain a pressure differential and promote flow. The tip of the trocar can be manipulated to distribute the talc widely. Adequate distribution results when a snowstorm effect is witnessed in the thoracic cavity. It is particularly important to confirm adequate coverage of the apical, visceral, and parietal pleura with tut. A 16 French chest tube is then placed and the procedure terminated. The patient made an uneventful recovery. --- Not medical advice · citation policy: https://library.globalcastmd.com/ai