In addition, we thought that the short rigid thoracoscopy mantle made it difficult to hold the FB tip in place, and that its elliptic inner diameter could not be maintained airtight. We used a straight cylindric outer sheath which can be easily inserted in a manner similar to a thoracic cavity drain, and since the sheath is made of metal, the FB can be passed smoothly. In addition, airtightness in the thoracic cavity following insertion of the FB can be maintained to a certain degree. Since the effective length is 21.5 cm, even though 10 cm is inserted into the thoracic cavity, 10 cm still remains outside of the thoracic wall.
This made it easier to hold by hand, assuring that the inserted tip of the FB can be held in place. Tonotsuka et al used radiography to assure that the FB reached the target lesion. Our procedure does not require radiography at all, and preoperative thoracic radiography was not performed in any of the cases. In addition, there is minimal pain during the procedure compared to the use of a rigid thoracoscope; a 13-year-old girl was treated under local anesthesia the same as an adult. We believe the reason is that no stress is applied to the ribs, since the FB tip is flexible, and the portion protruding from the mantle is freely adjustable. Our technique requires only about the same level of expertise required for the insertion of a thoracic cavity drain, and it is fully manageable by internists alone.