• Kenji Hazama, Akinori Akashi, Norihisa Shigemura, and Tomoyuki Nakagiri.
• Department of General Thoracic Surgery, Takarazuka Municipal Hospital, 4-5-1 Kohama, Takarazuka, Hyogo 665-0827, Japan.
• Eur J Cardiothorac Surg. 2003 Jul 1; 24 (1): 139-44.

ObjectiveThe purpose of this study was to establish a new surgical technique of thoracoscopic laser ablation for the patients of primary spontaneous pneumothorax (PSP) with small bullae, by using endoscopic equipment with a 2-mm diameter.MethodAccording to the size of a bulla identified by high-resolution computed tomography (HRCT), we have a protocol to determine an indication; the conventional video-assisted thoracic surgery (VATS) procedure by both stapler bullectomy and laser ablation to visceral pleura surrounding the bulla (bullae size: greater than 2 cm), or a new VATS procedure using needle shaped thoracoscopy and endoscopic equipment with a 2-mm diameter (needle VATS) by laser bulla ablation alone (bullae size: less than 2 cm).ResultsThe conventional VATS was performed in 54 patients and needle VATS in 60 patients. In the needle VATS group, operation time was shorter than that of the VATS group (39+/-17 min vs. 56+/-22 min). Use of non-steroidal anti-inflammatory drugs for postoperative wound pain could be reduced in the needle VATS group (3% vs. 56%). There were no complications in the needle VATS group, but three complications (5.6%) in the VATS group, including prolonged air leakage (>4 days) in two and refractory intercostal pain in one. The rate of recurrence after the operation was similar in both groups (3.7% vs. 3.3%). The needle VATS allowed wound healing without a scar and reduced the patient's cosmetic problems.ConclusionThe needle VATS procedure for patients with a bulla size less than 2-cm diameter was as useful as the conventional VATS procedure.

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