Thoracoscopic Ipsilateral Approach to Contralateral Bullous Lesion in Patients with Bilateral Spontaneous Pneumothorax

Background. Video-assisted thoracic surgery (VATS) has gained a prominent role in routine thoracic surgical practice. This study describes a novel ipsilateral approach to a contralateral bullous lesion using VATS to achieve simultaneous bilateral bleb excision and pleurodesis. Methods. From 2001 to 2003, 6 patients underwent our ipsilateral approach with VATS for bilateral pneumothorax. The clinical features, surgical indications, and patient outcomes were reviewed. Results. All the patients were men between 18 and 35 years old (mean age, 25.8 years). The ipsilateral-approach VATS procedure for bilateral pneumothorax was performed successfully in 4 patients. Two patients were switched to a one-stage sequential bilateral VATS procedure. The bullous lesions were at the apex or confined to the upper lobe in 5 patients; multiple lobes were involved in 1 patient. The bullae were resected with an Endo-GIA stapler or ligated with a homemade endoloop. The mean duration of operation was 54.8 minutes. The mean time of chest tube removal was 4.7 days after insertion, and the mean postoperative stay was 5.7 days. There was no recurrence of pneumothorax during the follow-up period. Conclusions. The thoracoscopic ipsilateral approach is technically feasible for treating patients with bilateral pneumothorax.