[Thoracoscopic surgery for pneumothorax with bullous emphysema in an elderly patient: a case report]

Recent advances in optical and endoscopic operating instruments have made thoracoscopic surgery easier. The authors report the case of an 83-year-old patient who was referred to our hospital for right spontaneous pneumothorax associated with severe bullous emphysema. Chest X-ray films showed 40% collapse of right lung and the right spontaneous pneumothorax was treated by chest tube drainage for 3 weeks. However air leak was not decreased and subcutaneous emphysema appeared. Chest computerized tomography revealed multiple bullae. Thoracoscopic surgery was performed because of preservation of the respiratory function. The ruptured bulla was resected by using ENDO GIA and the other multiple bullae were resected similarly in order to improve the pulmonary function. A surgical drain was removed on the 14th postoperative day because of a little air leak continuing. His postoperative course was uneventful after removal of the chest drain. He was discharged on 27th postoperative day and had no shortness of breath in daily life. From our experience, thoracoscopic surgery appears to be much better than thoracotomy for spontaneous pneumothorax because of much less postoperative disability and preservation of respiratory function.