Minimally invasive talc insufflation: a new technique with no need for thoracoscopy

Talc insufflation is usually performed by thoracic surgeons in the operating room through video-assisted thoracoscopic surgery (VATS) or by pulmonologists in a specially equipped suite (medical thoracoscopy). These techniques can cause postoperative pain, require placement of port sites through small incisions, and increase waiting time and cost for patients who have no need for visual inspection of the pleura, biopsy, or apical bleb resection. Poudrage (French for powdering) with asbestos-free talcum powder (talc) is a proven technique with wide acceptance for treatment of pneumothorax. Use of a small, 4 g, canister of talc under pressure is a commonly used method to aerosolize and apply it using the supplied Teflon catheters. This report describes a patient who was too ill for almost any formal procedure in whom we performed talc poudrage by an even less invasive technique, using controlled permissive pneumothorax in the radiology suite by using a small needle, guide wire, and dilator with no thoracoscopy ports. Given the increased expense, frequent waiting time delay, and diminished access to care, we believe this technique deserves consideration in patients who are poor surgical candidates and perhaps in the young patient with no computed tomography evidence that might suggest the need for apical bleb resection, biopsy, or additional investigation.