Chest
Volume 106, Issue 2, August 1994, Pages 338-341
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Clinical Investigations: The Pleura
Nd-YAG Laser Pleurodesis Via Thoracoscopy: Nd-YAG Laser Pleurodesis Via Thoracoscopy

https://doi.org/10.1378/chest.106.2.338Get rights and content

From January 1986 to February 1993, 85 patients with spontaneous pneumothorax were treated in our department by a new endoscopic procedure using an Nd-YAG laser beam via thoracoscopy to obtain permanent pleurodesis and to treat the lung lesion responsible for the air leak. The 55 men and 30 women ranged in age from 16 to 51 years (mean age 26 years). Under general anesthesia the thoracoscope was introduced through a 1-cm incision in the anterior axillary line of the fourth intercostal space. In 68 patients small blebs (less than 2 cm in diameter) were detected and successfully resected with low power Nd-YAG laser pulses. In two patients found at thoracoscopy to have lesions larger than 2 cm, the Nd-YAG laser failed to seal the air leak and thoracotomy was performed. Air leaks were not detected at endoscopy in the remaining patients. After treatment of the lung lesions, the parietal pleura was abraded by using the laser energy. There were no side effects. Eighty patients were treated successfully without recurrence (maximum follow-up 86 months). Three other patients developed recurrence of pneumothorax after 5,6, and 24 weeks, and surgery was considered mandatory in 2 of them. At thoracotomy, in both patients, a small bleb was detected in the lower lobe and resected. The whole upper lobe was strongly adherent to the parietal pleura in the site of previous laser abrasion. The authors conclude that Nd-YAG laser via thoracoscopy should be considered as a viable therapeutic option in patients with spontaneous pneumothorax.

Section snippets

Methods

Thoracoscopic Nd-YAG laser pleurodesis was performed as an alternative to conventional chest drainage or chemical pleurodesis. All patients were informed of the possibility of subsequent thoracotomy if the procedure did not achieve satisfactory results.

Eligibility criteria for this therapy consisted of primary or recurrent spontaneous pneumothorax. Cases of neonatal, iatrogenic, traumatic or neoplastic pneumothorax, and patients with acute respiratory insufficiency were excluded. The procedure

Results

A total of 85 patients with spontaneous pneumothorax were treated with this procedure from January 1986 to February 1993. The age of the 55 men and the 30 women ranged from 16 to 51 years (average age 26 years). All patients tolerated the procedure well and there were no major complications. The average postoperative hospital stay was 5 days. In 17 patients, no lung cysts or blebs were detected at thoracoscopy. In all of these patients, the Nd-YAG laser energy was directed only to the parietal

Discussion

Although there is general agreement regarding the pathogenesis of spontaneous pneumothorax, there is no consensus concerning the best treatment. The preferred therapy must achieve rapid re-expansion of the lung, obliteration of blebs, and permanent pleurodesis as prophylaxis against recurrence. Moreover all these objectives must be obtained with the least discomfort possible.

Until 2 years ago, chest drainage was the mainstay of therapy. However, it cannot be considered a radical method because

Acknowledgments

The authors thank Prof. J. Patrick Barron of Tokyo Medical College Hospital for his revision of the manuscript.

References (13)

There are more references available in the full text version of this article.

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