Treatment of spontaneous pneumothorax under videosurgery, 32 cases (with videofilm presentation)]

From September, 1991, to June, 1992, 32 cases of pneumothorax were operated with thoracoscopy (video surgery). The indication was established for second recurrence in 6 cases, first recurrence in 14 cases, a persistent bulla or a lung failing to return to the wall after a first pneumothorax in 5 cases, and in the presence of a large pulmonary bulla on radiographs or CT scans during an initial episode in the last 7 cases. Thoracic CT was performed in 18 cases and demonstrated a system of bullae in 14 (13 in the apical segment and 1 in the segmentum apicale). The procedure included exeresis of the bullae on endo-GIA with apical and posterolateral parietal pleurectomy. In two cases, conversion into axillary thoracotomy was required because of extensive pleural adhesion in one case and of a technical problem in the other. The average duration of surgery was 72 mn. The thoracic drains were removed on the 2nd and 3rd postoperative days. Partial pleural detachment occurred in two cases, one on the 4th day and the other on the 5th day after surgery, with spontaneous return to the wall on the 8th day in both cases. The average stay in hospital was of 6 days. All patients were examined 15 days after discharge with a control radiograph, which was normal in all cases. No patient complained of parietal pain when no conversion into thoracotomy was made.