StayCurrentMD · Thoracoscopic Treatment of Spontaneous Pneumothorax
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Video3 min·Published Feb 2020Older

Thoracoscopic Treatment of Spontaneous Pneumothorax

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What the experts said0 expert statements · 17 host summaries
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
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The patient had undergone thoracoscopic treatment of a left spontaneous pneumothorax approximately 2 years earlier after failed non-operative management
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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
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The patient is placed in the lateral decubitus position with an axillary roll on a beanbag for thoracoscopic pneumothorax treatment
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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
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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
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Several blebs were identified in the lung apex during full examination
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The initial stapler firing did not capture an adequate margin under the blebs on the posterior surface
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The stapler should be applied across a more generous margin of grossly normal lung tissue when initial margin is inadequate
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Three firings of the stapler were necessary to completely remove the apical wedge in this case
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The specimen can be removed directly through the largest chest wall incision
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A pressure of 15 millimeters of mercury and a flow of 4 L per minute is used to insufflate the talc
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It is important to keep the second trocar open in order to maintain a pressure differential and promote flow during talc insufflation
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The tip of the trocar can be manipulated to distribute the talc widely
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Adequate talc distribution results when a snowstorm effect is witnessed in the thoracic cavity
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It is particularly important to confirm adequate coverage of the apical, visceral, and parietal pleura with talc
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A 16 French chest tube is placed at the conclusion of the procedure
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