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Thoracoscopic modified pleural tent for spontaneous pneumothorax
Riken Kawachi1, Rie Matsuwaki2, Keisei Tachibana2
1Department of Thoracic and Thyroid Surgery, Kyorin University Hospital, Tokyo, Japan rkawachi@ks.kyorin-u.ac.jp.
Objectives:
We developed a modified pleural tent (m-tent) procedure and used it in our hospital in almost 30 consecutive patients with spontaneous pneumothorax. The objective of this study was to clarify the feasibility and effectiveness of a thoracoscopic m-tent for the treatment of spontaneous pneumothorax.
Methods:
From July 2013 to November 2014, 107 patients with spontaneous pneumothorax were treated in our institution. Eighty-nine of these patients were analysed retrospectively. The inclusion criteria for thoracoscopic m-tent for spontaneous pneumothorax were multiple and widespread bullae, postoperative relapse and secondary spontaneous pneumothorax. The surgical procedures were usually performed through three ports. After bullectomy, an m-tent is made to strip the parietal pleura off the chest wall from about the level of the fourth or fifth rib to the apex, and two or three ligations are then applied to fix the pleural tent and lung parenchyma. Patients in whom an m-tent was not indicated underwent bullectomy plus coverage using absorbable materials.
Results:
Twenty-seven patients underwent bullectomy plus m-tent (m-tent group) and 62 underwent bullectomy plus coverage over a staple line using an absorbable material such as a polyglycolic acid sheet or nitrocellulose sheet (coverage group). No severe postoperative complications were observed in either group. The m-tent and coverage groups showed significant differences in operation time (129 vs 86 min, mean), haemorrhage (12.8 vs 7.2 ml), postoperative hospital stay (3.7 vs 2.9 days) and postoperative painkiller intake (8.6 vs 6.8 days). Recurrence was observed in 1 (3.7%) and 2 patients (3.2%), respectively.
Conclusions:
The thoracoscopic m-tent procedure requires a longer operation, a longer hospital stay and greater painkiller intake. However, these differences are acceptable, and an m-tent should be considered as an option for pleural reinforcement in spontaneous pneumothorax, especially in patients who are complicated with severe pulmonary emphysema, widespread bullae or recurrent pneumothorax.
Insights
The modified pleural tent (m-tent) procedure is a feasible option for spontaneous pneumothorax, offering comparable recurrence rates to standard coverage but with increased operative time and hospital stay. This technique is particularly beneficial for patients with severe emphysema or recurrent pneumothorax.
Area of Science:
- Thoracic Surgery
- Pulmonology
Background:
- Spontaneous pneumothorax management often involves bullectomy.
- Pleural reinforcement techniques aim to reduce recurrence rates.
- The modified pleural tent (m-tent) is a less common surgical approach.
Purpose of the Study:
- To evaluate the feasibility and effectiveness of the thoracoscopic modified pleural tent (m-tent) procedure for treating spontaneous pneumothorax.
- To compare the m-tent procedure with standard bullectomy plus coverage techniques.
Main Methods:
- A retrospective analysis of 89 patients with spontaneous pneumothorax treated between July 2013 and November 2014.
- Patients were divided into two groups: m-tent procedure (n=27) and bullectomy with absorbable material coverage (n=62).
- Inclusion criteria for m-tent included widespread bullae, postoperative relapse, and secondary spontaneous pneumothorax.
Main Results:
- The m-tent group experienced longer operation times (129 vs. 86 min), increased hemorrhage (12.8 vs. 7.2 ml), longer hospital stays (3.7 vs. 2.9 days), and greater painkiller intake (8.6 vs. 6.8 days) compared to the coverage group.
- Recurrence rates were low and similar between groups (3.7% for m-tent vs. 3.2% for coverage).
- No severe postoperative complications were noted in either group.
Conclusions:
- The thoracoscopic m-tent procedure is a viable option for spontaneous pneumothorax, despite longer operation times and hospital stays.
- The increased procedural demands are considered acceptable given the comparable recurrence rates.
- The m-tent technique is particularly recommended for patients with severe pulmonary emphysema, widespread bullae, or recurrent pneumothorax.
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