[Occlusion with interrupted titanium clips for ruptured bullae under video-assisted thoracoscopic surgery]

Spontaneous pneumothorax is a common disease and as many as 20% of these patients should be operated because of a recurrent pneumothorax, persistent air leak, or failure to completely reexpand the lung. From January 1993 until March 1994, on the basis of experiment, we performed video-assisted thoracoscopic surgery (VATS) intervention and talc pleurodesis on 8 patients with spontaneous pneumothorax caused by ruptured bullae, and designed a new procedure of occluding the bullae with interruptured titanium clips. This procedure has some advantages of complete occlusion of lung tissue at the base of the bulla, minimal loss of lung tissue, effectively preventing leakage and recurrent pneumothoraces, and enough capacity of anti-tension while the lung expands. Also Authors have advocated giving a negative pressure suction to opsilateral lumen of the Carlen's tube interbation to visualize adequately the intrathoracic structures, while selective lung ventilation is performed. This method keeps hemodynamic stability and is performed more easily and safely than that of positive pressure insufflation is done. Postoperatively, complete lung expansion was obtained in all patients. There were no perioperative complications related to VATS, and no recurrences to date. These early results with thoracoscopic management of spontaneous pneumothorax caused by ruptured bullae have encouraging.