Transcollation technique in the thoracoscopic treatment of primary spontaneous pneumothorax

OBJECTIVES: The already low invasiveness of the thoracoscopic treatment of spontaneous pneumothorax may be further reduced by the transcollation® technique. Herein, we report our further experience with a new device, to coagulate blebs and bullae, compared with contrastto endostapler resection. METHODS: Data of patients with recurrent or persistent spontaneous pneumothorax, who underwent thoracoscopic treatment, were prospectively collected and reviewed. Those with blebs or bullae (Stages III and IV in accordance with Vanderschueren’s classification) were treatedwithanewdevice,basedoncouplingsalinesolutionperfusionwithradiofrequencyenergy.Thecombinationof fluidwithradiofrequencyallowsthesealing of tissue, avoiding charring or burning.Mostoperationswere performed through two1-cmincisions only. RESULTS: From 2005 to 2010, 73 patients were treated. These were 59 males (80.8%) and 14 females (19.2%), with a mean age of 27.9 years[standarddeviation(SD):11.7].Forty-threepatientsunderwentgeneral anaesthesiawithselectiveintubation,9awakeepiduralanaesthesia and 21 spontaneous breathing anaesthesia with laryngeal mask. The mean operation time was 31 min (SD: 10.2). The median postoperative drainage period and hospital stay were 2 days (range of 1–11) and 3 days (range of 2–11), respectively. Prolonged air leak occurredin 1patient (1.4%).Overamean follow-upperiod of 60 months (SD: 22.5), tworecurrences (2.7%)were reported. CONCLUSIONS: The transcollation® technique by cold coagulation of blebs and bullae seems to be effective in the treatment of primary spontaneous pneumothorax. Owing to its potential advantages, it appears to be particularly suitable to be associated with awake epidural and LMA anaesthesia.