Minimally invasive bullae ablation: Result using homemade endoloop

Purpose: Endoscopic stapling device has been a preferred method for resection of parenchymal blebs or bullae, the stapling device however is not inexpensive. Due to cost containment, we have used the self-made endoloop as an alternative method which assisted us in performing bullae ablation in a cost effective manner. This report assess the efficacy of the thoracoscopic self-made endoloop ligation of parenchymal blebs and bullae in patients with spontaneous pneumothorax. Method: In a 4-year period (1992-1996), we reviewed a total of 376 thoracoscopic endoloop ligations of pulmonary blebs and bullae for definitive treatment of spontaneous pneumothorax in 300 patients. Patients selected for surgery includes recurrence (156), bilaterality of the disease (23), hemopneumothorax (7), radiologically demonstrated large bulk (9), persistent air leak (76) and nonexpansion of the lung (29). All clinical data were collected from chart review. Only patients with thoracoscopic confirmation of the bullae were included in this evaluation. Thoracoscopic ligation using No. 1 PDS (polydiaxanone suture) was carried out under general anesthesia and single lung ventilation. Result: There was no operative death. Early postoperative complications include 1 patient who required re-exploration for a dislodged endoloop and 13 with postoperative minor wound infections. The average postoperative hospitalization was 4.5 days. Two hundred fifty-eight patients (86% of all patients) were followed-up for a median of 28 (1-46) months after surgery. There have been no recurrences to date. Conclusions: By comparison, our results showed that thoracoscopic endoloop ligation is as effective and safe as is stapler resection with a lower cost, fewer complications and a lower recurrent rate in managing the blebs and parenchyma bulla. Clinical Implication: On the basis of our results, we advocate the use of the self-made endoloop for ligation of parenchymal blebs and bulla in patients with spontaneous pneumothorax to achieve a truly cost effective and minimally invasive thoracoscopic procedure.