Chest
Clinical Investigations: The PleuraNd-YAG Laser Pleurodesis Via Thoracoscopy: Nd-YAG Laser Pleurodesis Via Thoracoscopy
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.
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Cited by (17)
Management of Pneumothorax
2021, Clinics in Chest MedicineCitation Excerpt :Mechanical pleural abrasion during thoracotomy was first described in 1941 to decrease recurrence of pneumothorax.57 This is most commonly achieved with the use of a scratch pad but has also been reported using Nd-YAG laser.58 Although commonly performed, mechanical pleurodesis remains controversial as some trials have shown increased complications (mostly bleeding) and no decrease in recurrence of pneumothorax.59,60
Evidence-Based Suggestions for Management of Air Leaks
2010, Thoracic Surgery ClinicsCitation Excerpt :Pneumoperitoneum instilled via a transabdominal catheter has been reported to be effective in some cases.74,75 Surgical options to accomplish pleural symphysis or control the source of an AAL include video-assisted thoracoscopic surgery (VATS) with parenchymal stapling, VATS with chemical pleurodesis, VATS with pleural abrasion,76,77 VATS with application of topical sealants,78,79 and the less well-supported use of VATS with laser sealing of the site of leak.80 These procedures should ideally be performed promptly after it is clear that bedside pleurodesis has failed, so that an evolving partial pleurodesis does not complicate the operation.
Management of Alveolar Air Leaks After Pulmonary Resection
2010, Annals of Thoracic SurgeryCitation Excerpt :Pneumoperitoneum instilled through a transabdominal catheter has been reported to be effective in some cases [30, 47, 48]. Surgical options to accomplish pleural symphysis or control the source of an alveolar air leak, or both, include video-assisted thoracic surgery (VATS) with parenchymal stapling, VATS with chemical pleurodesis, VATS with pleural abrasion [49, 50], VATS with application of topical sealants [51, 52], and the less well-supported use of VATS with laser sealing of the site of leak [53]. These procedures should ideally be carried out promptly (within days) after it is clear that bedside pleurodesis has failed, so that the time required to develop a pleural space infection is minimized and an evolving partial pleurodesis does not complicate the operation.
Intraoperative techniques to prevent air leaks
2002, Chest Surgery Clinics of North AmericaSpontaneous pneumothorax in cocaine sniffers [4]
1998, American Journal of Emergency MedicineSpontaneous pneumothorax: Treatment of 45 consecutive cases. Preliminary results of therapeutic video-assisted thoracoscopy
1997, Archivos de Bronconeumologia