A New Microsurgical Approach to the Treatment of Primary Spontaneous Pneumothorax

This video shows a microsurgical approach to the treatment of primary spontaneous pneumothorax. A surgical incision of less than 2 cm in length was performed on the mid-axillary line in the 8th intercostal space. Using a 5 mm diameter 30 degree thoracoscope, a distrophic area at the apex of the superior lobe was identified. A non-reabsorbable braided suture was passed from outside the chest wall, and a slipknot was tied in order to create a loop. The lesion was then elevated at the center of the chest cavity by pulling the thread on the side of the chest wall, creating an angle and making space to introduce a stapler to excise the lesion. The lower lobe was retracted superiorly and the inferior pulmonary ligament was transected with a cautery hook. Mechanical abrasion pleurodesis of the entire chest cavity was performed using a cautery tip cleaner. Finally, a 24 French chest tube was inserted into the pleural cavity through the incision site and the wound was closed around the tube.