[Video assisted thoracic surgery for the treatment of catamenial pneumothorax]

Video assisted thoracic surgery (VATS) was applied in 3 cases of pneumothorax combined with pathologic changes in the diaphragm (two cases of catamenial pneumothorax and one case of suspected catamenial pneumothorax). Case 1, 39-year-old woman, was preoperatively diagnosed as catamenial pneumothorax in the right lung. Thoracoscope was inserted through the 5th intercostal anterior axillary line and the lesion with the pathologic changes in the central tendon of the diaphragm was incised and sutured with Endo-GIA and Endo-STAPELAR. Case 2, 42-year-old woman, was confirmed to have pathologic changes in the central tendon after insertion of thoracoscope through the 5th intercostal anterior axillary line. Minithoracotomy of 50 mm in size was added close to the center of the diaphragm and direct incision and suture of that part were performed. Case 3, 47-year-old woman, underwent thoracoscopy through the 5th intercostal mid-axillary line and bulla in the S2 interlobar surface was incised with Endo-GIA. In this case, the diaphragm was partially incised through additional minithoracotomy because some lesions were detected on that part. VATS can fully be carried out for pathologic changes in the diaphragm in catamenial pneumothorax. Since catamenial pneumothorax may be complicated with another pathologic changes in the diaphragm (Case 1) or in the visceral pleura (Case 3), the whole thoracic cavity, including diaphragm and visceral pleura, should be carefully observed under thoracoscopy. Application of minithoracotomy-associated thoracoscopic surgery is a useful method in the case to whom catamenial pneumothorax is definite or suspected.