Thoracoscopic apico-posterior transmediastinal approach for bilateral spontaneous pneumothorax

Abstract

Thoracotomic, trans-sternal or thoracoscopic approaches through transmediastinal access for contralateral lung are operative alternatives for bilateral pulmonary lesions. Video-assisted thoracoscopic surgery (VATS) for spontaneous pneumothorax (PTX) is now considered as a standard approach. Herein, we report a novel method of apico-posterior transmediastinal ipsilateral approach using VATS to perform simultaneous bilateral bullectomy in two young men with simultaneous bilateral spontaneous PTX. This new VATS access is technically feasible and may mitigate postoperative pain and avoid a secondary thoracic incision.

Thoracoscopic Bilateral Bullectomy for Simultaneously Developed Bilateral Primary Spontaneous Pneumothorax: Ipsilateral Transmediastinal versus Bilateral Sequential Approach

“…Also this procedure has some contraindications, such as a history of sternotomy and intolerance to one-lung ventilation. We first reported a new VATS technique for BB via apicoposterior TM access to the contralateral side, 10 and then evaluated feasibility of this method in 10 selected BPSP patients. 11 Therefore, we compared the TM VATS with the BS VATS for simultaneously developed BPSP patients at our institution.…”

“…The TM approach for BPSP was precisely described in two published papers. 10,11 Briefly, the patient was placed in leftdown decubitus position and right-side VATS approach was used under general anesthesia using one-lung ventilation with double-lumen endotracheal tube. Three thoracoports for a thoracoscope, an Endostapler, and other instruments were inserted at the fifth or sixth intercostal space (ICS) on the middle axillary line, and at the third or fourth ICS on the anterior and posterior axillary line.…”

“…[6][7][8][9] Recently, we have reported a new, modified VATS technique for BPSP, which is bilateral bullectomy (BB) through the apicoposterior TM region to the contralateral thoracic cavity. 10,11 Although BS VATS for BPSP is safe and well-established surgical approach according to several reports, 5,12 it uses multiple surgical drapes, requires bilateral multiple incisional wounds, prolongs surgical time, needs inconvenient bilateral chest tube drain (CTD), and may cause perioperative pain and prolonged hospital stay. This technique may be technically demanding and challenging, but it is minimally invasive, yields better cosmetic results, and may reduce pain and is cost-effective.…”

Thoracoscopic Simultaneous Bilateral Bullectomy Through Apicoposterior Transmediastinal Access for Bilateral Spontaneous Pneumothorax: A Challenging Approach

“…Although a bilateral thoracoscopic approach is safe and well established according to several reports, it needs bilateral multiple incisional wounds, uses multiple surgical drapes, has a long surgical time, uses inconvenient bilateral CTDs, causes postoperative pain, and its recurrence rate is still controversial. A few reports demonstrate that transmediastinal contralateral approaches are a technically feasible and good therapeutic option in selected cases of BPTX [3, 6, 7]. Nazari et al [3] reported a new technique for BB and pleurectomy via subaxillary minithoracotomy and apicoposterior transmediastinal access to the contralateral side in 13 selected BPTX patients.…”

Videothoracoscopic surgical approach for spontaneous pneumothorax: review of the pertinent literature

“…Recently, a few researchers [ 64 - 66 ] have introduced, as a further advanced novel procedure, a thoracoscopic ipsilateral transmediastinal approach to contralateral as well as ipsilateral bullous lesions in patients with bilateral pneumothorax in the supine position, although the results were obtained under limited situations. Further new techniques with the VATS procedure will likely be developed in the future.…”