Thoracoscopic treatment of recurrent pneumothorax by pleurabrushing and argon beam coagulation

There is no consensus in treating relapsing pneumothorax and pleural effusion. Various types of treatment exist. While open chest surgery with mechanical pleurodesis or pleurectomy is effective, with a recurrence rate close to zero, for patients in poor conditions this treatment may be disadvantageous because of its invasiveness. Therefore minimally invasive techniques using antibiotics, fibrin glue, talcum, kaolin, blood and silver nitrate have been described. Several side effects accompany these agents, and the recurrence rate is between 5-39%. New video-assisted thoracoscopic techniques have enabled surgeons to combine the effectiveness of pleurectomy with minimal invasiveness. Results using these techniques are encouraging. As with open pleurectomy, bleeding complications have been reported, Further disadvantages have to be considered, such as the effect of destroying the parietal layer of the pleura, which may complicate subsequent operations in the thoracic cavity. A technique for avoiding this pleural injury, while maintaining the same efficiency as open pleural abrasion and coagulation is described below.