Ablation of weak emphysematous visceral pleura by an ultrasonically activated device for spontaneous pneumothorax

Abstract

Staple bullectomy is widely performed for the thoracoscopic treatment of spontaneous pneumothorax. When weak emphysematous changewas observed to extend to the whole pleura around the localized bulla, weak emphysematous pleura always remain around the staplerafter bullectomy. Such cases along with weak pleural surfaces around staplers belong to the groups at high risk of postoperative recurrence.We performed thoracoscopic ablation using an ultrasonically activated device (USAD) for such lesions and studied the efficacy. From April2002 to December 2006, a total of 85 surgeries for spontaneous pneumothorax were performed in this hospital, of which 34 cases underwentablation with a USAD for a weak pleural surface. No complications due to ablation were observed. Recurrence was observed in foursubjects, but the cause of recurrence was the regeneration of a bulla outside the range of the ablation and was unrelated to the ablationitself. Moreover, significant white pleural thickening was observed at the ablation sites, demonstrating a stiffening effect of the weakvisceral pleura. Ablation using a USAD is a safe and easy operative method, and it is an appropriate operative system as a stiffeningprocedure for a visceral pleura. © 2011 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.