Consequently, the proportion of cases that actually required thoracotomy was apparently about 22 percent when combined with recurrent cases following SPECT. We performed rigid thoracoscopy on almost all cases from 1981 through 1987 without excluding, on the basis of preoperational thoracic cavity radiography, cases that did not heal by conservative therapies. Although our success rate with SPECT was only 17 out of 31 (55 percent), only 13 (16 percent) of the 79 cases ultimately required thoracotomy.
Considering the fact that the subjects of thoracoscopic therapy are cases of spontaneous pneumothorax that could not be healed internally, our therapeutic index was very good, and our recurrence rate was low; however, this treatment is apparently not widely used, possibly because surgeons more readily perform a thoracotomy, and internists believe that rigid thoracoscopy involves high technology that requires the cooperation of a surgeon. In order for thoracoscopic therapy to be widely used for the treatment of spontaneous pneumothorax, it is important to improve the cure rate and simplify the procedure for internists to handle without the help of a surgeon.