The Feasibility of Single Incision Thoracoscopic Surgery for Primary Spontaneous Pneumothorax Using a Single-incision Laparoscopic Surgery Port Under Single-lumen Endotracheal Tube Intubation With Co2 Gas Insufflation

Hyun Koo Kim, MD PhD, Ho Kyung Sung, MD, Hyun Joo Lee, RN, Jiae Min, RN, Young Ho Choi, MD PhD. College of Medicine, Korea University Guro Hospital

Background: Single incision laparoscopic surgery (SILS) has recently been used by general surgeons to perform cholecystectomy and pre-peritoneal hernia repair. The SILS approach with SILS port had the potential merits of decreasing the duration of anesthesia by using single-lumen endotracheal tube intubation with CO2 gas insufflation. We performed single incision thracoscopic surgery for primary spontaneous pneumothorax using a SILS port with CO2 gas insufflation and evaluated the feasibility and safety of this procedure.
Methods: Thirty patients with primary spontaneous pneumothorax underwent bleb resection with chemical and mechanical pleurodesis in our clinic, from October 2010 to August 2011. Single-lumen endotracheal tube with CO2 gas insufflation was used for obtaining the optimal surgical field. An incision of 2.5 cm was made at the previous closed thoracotomy site. A single flexible port (SILS port) was placed to access the thoracic cavity, and a 5 mm thoracoscopy, articulating gasper and endoGIA stapler were introduced through port channels.
Results: Thirty-one male patients (mean age 21.2 ± 7.79 years) were enrolled in this study. The mean time from endotracheal intubation to the incision was 15.2 ± 5.28 minutes (range 9~25 minutes), the mean operation time was 33.2 ± 15.38 minutes (range 13~77 minutes) and the total time under anesthesia was 59.3 ± 13.16 minutes (range 41~95 minutes). There were no wound infections, early recurrences or readmissions. The chest tube was removed on average at postoperative day 3.6 ± 1.3 (range 2~5 days) and patients were discharged from the hospital without complications on average at postoperative day 4.5 ± 1.3 (range 3~6 days). During the mean follow-up period of 4.9 ± 3.15 months (range 0.6~10.4 months), there was no recurrence on the side that underwent surgery.
Conclusions: Single incision thracoscopic surgery for primary spontaneous pneumothorax using a SILS port under single-lumen endotracheal tube intubation with CO2 gas insufflation was technically feasible. Further work and development of a specific thoracic single port are needed to refine the use and advantages of this procedure.
 

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