Comparative Studies Using a Rigid Thoracoscope and Fiberoptic Bronchoscope to Iteat Spontaneous Pneumothorax (7)
The results of using the outer sheath and FB method described herein on 19 patients with spontaneous pneumothorax are shown in Table 2 and in the following tabulation, listing numbers of cases (numbers within parentheses are percentages):
Successful high-frequency coagulation 8 (42)
Successful the first time 1
Recurrence after improvement following coagulation; repeat coagulation 1
Healed after fibrinogen and thrombin injection and spray 7 (37)
Recurrence after high-frequency coagulation; fibrinogen and thrombin injected 1
Fibrinogen and thrombin injection into blebs 2
Fibrinogen and thrombin injection and spray 1
After high-frequency coagulation, fibrinogen and thrombin sprayed 2
Fibrinogen and thrombin sprayed 1
Comparative Studies Using a Rigid Thoracoscope and Fiberoptic Bronchoscope to Iteat Spontaneous Pneumothorax (6)
The outer sheath is usually inserted under local anesthesia into the anterior axillary line between the fourth and fifth intercostal space while the patient is in a lateral position with the unaffected side down in the same manner used for the insertion of a thoracic drain. After removal of the mandrin, a FB is inserted, and the thoracic cavity is observed. The FB passes smoothly through the outer sheath, and since the length of the FB protruding from the tip is freely adjustable, extensive observations are possible, including the posterior surface of the lung, as well as the interlobar surfaces.
Comparative Studies Using a Rigid Thoracoscope and Fiberoptic Bronchoscope to Iteat Spontaneous Pneumothorax (5)
Thoracoscopic Therapy Using The FB
Materials and Methods
A total of 19 cases were treated using an FB. The group consisted of 14 cases where rest and thoracic cavity drainage did not provide sufficient improvement for discharge, 4 patients readmitted due to recurrence after discharge following thoracic drainage, and one case of recurrence and readmission following improvement after rigid thoracoscopic bleb electrocoagulation.
Comparative Studies Using a Rigid Thoracoscope and Fiberoptic Bronchoscope to Iteat Spontaneous Pneumothorax (4)
Blebs were endoscopically visible in only about one half of the group, and healing occurred in most members of this group following coagulation therapy. Consequently, therapeutic efficacy was directly related to our ability to visualize blebs. In only five cases (16 percent) in which blebs could be visualized was therapy unsuccessful; however, three of these cases involved giant blebs with a diameter of 4 cm or greater, and two cases involved multiple blebs. If we consider only those cases in which all blebs were visible, an excellent success rate of 17 out of 22 cases (77 percent) was achieved.
Comparative Studies Using a Rigid Thoracoscope and Fiberoptic Bronchoscope to Iteat Spontaneous Pneumothorax (3)
All 17 patients improved and were discharged. Only 3 (17 percent) of the 17 patients experienced a recurrence of spontaneous pneumothorax at 1 month, 5 months, and 4 years after treatment, respectively. The range of the period of observation was 20 to 72 months, with an average of 51 months. Consequently, when therapy was successful, the rate of recurrence was low. Only 13 cases (16 percent) required thoracotomy, which was a 50 percent reduction in frequency compared to our experience over a four-year period prior to the use of a rigid thoracoscope; however, the success rate for the 17 of 31 cases which did not respond to conservative therapy was only 55 percent.
Comparative Studies Using a Rigid Thoracoscope and Fiberoptic Bronchoscope to Iteat Spontaneous Pneumothorax (2)
Bleb Electrocoagulation Therapy Using a Rigid Thoracoscope
Materials and Methods
Between January 1981 and December 1987, a total of 31 out of 79 patients with spontaneous pneumothorax were treated using a rigid thoracoscopic procedure. Twenty-five patients were selected on the basis of a lack of improvement or the inability to discharge the patient after one to three weeks of treatment involving rest and thoracic cavity drainage. In addition, six patients were selected on the basis of recurrence and readmission after improvement and discharge following thoracic cavity drainage, etc. A rigid thoracoscope (Machida THR-SL-A) was inserted under local anesthesia into the anterior axillary line between the fourth and fifth intercostal space of the thoracic cavity to identify blebs. When blebs were found, we performed high-frequency bleb electrocoagulation.
Comparative Studies Using a Rigid Thoracoscope and Fiberoptic Bronchoscope to Iteat Spontaneous Pneumothorax (1)
Prior to 1978, the conventional treatment of pneumothorax generally consisted of conservative therapies such as rest, needle puncture, or thoracic cavity drainage; however, when those therapies were not effective or when relapse occurred, a thoracotomy was performed. This was the therapeutic policy at our hospital, as well. For example, between 1978 and 1980, eleven out of 32 patients with spontaneous pneumothorax who were admitted to our hospital required a thoracotomy; however, beginning in 1978, Takeno et al reported favorable results using a rigid thoracoscope and high-frequency electrocoagulation therapy (SPECT)2* in the treatment of blebs in patients with spontaneous pneumothorax where conservative therapy was ineffective. Consequently, in 1981, we adopted the SPECT thoracoscopic method for the treatment of spontaneous pneumothorax, where appropriate.