There were 9 out of 31 cases in which we could not find blebs by rigid thoracoscopy; however, there were only 5 cases, which represent only 6 percent of the total patients with spontaneous pneumothorax who were admitted, where blebs did not heal although we were able to find them. Based on these results, we thought it was possible to further reduce the thoracotomy rate by widening the visible area of the thoracoscope to assure that blebs are found. One method of widening the visible area for thoracotomy is to use a flexible thoracoscope, which has been built as a prototype but not yet generally marketed.
There are many reports* describing methods for using a FB as a thoracoscope. Gwin et al inserted a FB alone into the thoracic cavity; however, many workers used a mantle tube at the insertion of the FB into the thoracic cavity. Ben-Isaac and Simmons used a prototype cannula with an inner diameter of 5.2 mm, Senno et al used an Argyle chest tube, and Tonotsuka et al used a tracheotomy cannula or rigid thoracoscope mantle; however, in the case of a synthetic resin mantle tube such as the Argyle chest tube or tracheotomy cannulae, not only is the passage of an FB not smooth, but the tracheotomy cannula cannot be inserted easily into the thoracic cavity.