The objectives of broadening the visible thoracoscopic area and finding blebs were achieved in all cases, including three cases (cases 3, 13, and 17) in which blebs were found on the vertical septum side and four cases (cases 4, 14, 15 and 19) with pleural adhesions. High-frequency electrocoagulation was performed in 11 of the 19 cases (cases 1 to 11), and improvement and discharge were achieved in 10 of these cases (cases 1 to 10). We had to resort to a thoracotomy in one case (case 11) when the patients condition did not improve. No recurrences have occurred over an observation period of 4 to 26 months (average of 18.7 months) in 7 (cases 1 to 7) out of the 10 patients who improved and were discharged; however, recurrence occurred on the eighth day in one case (case 9) with a bleb in the pulmonary apex area and at one and three months after discharge in two cases (cases 8 and 10) of multiple blebs.
When the recurrent case (case 9) with a bleb in the pulmonary apex area was endoscop-ically reexamined, we found a punctured hole in the bleb due possibly to excessive electrocoagulation. In this one case, we injected 1 ml of a 4 percent fibrinogen solution and 1 ml of a thrombin solution into the bleb using a FB topical injection syringe and successfully achieved intrableb adhesion.