• Journal of Chest Surgery
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• v.23 no.4
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• pp.720-730
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• 1990

The complicated pulmonary emphysema including “Giant bullae” and spontaneous pneumothorax often involve both lungs, and controversy exists concerning which is the more rational means of surgical treatment-bilateral simultaneous operation or two staged operation. We report three cases of the complicated bilateral bullous emphysema and two cases of bilateral spontaneous pneumothorax treated through median sternotomy. We performed the ligation of bullae, bullectomy, cystectomy, wedge resection, and left lower lobectomy through median sternotomy. No technical problems were encountered through this approach, which provided maximum benefit with one operation In conclusions, median sternotomy may be appropriate for resection of emphysematous bullae, specially in a severe COPD patient who may be poorly tolerated the superimposed loss of respiratory function due to incisional pain, because median sternotomy permit bilateral exploration, minimal impairment of pulmonary function, simultaneous restoration of pulmonary function, less incisional pain than routine lateral thoracotomy.

• Journal of Chest Surgery
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• v.24 no.10
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• pp.1039-1043
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• 1991

The bullectomy, or sedge resection of the lung including bullae is the treatment of choice for the recurrent spontaneous pneumothorax, and but results in pleuropulmonary fistulae in postoperative periods in some emphysematous lungs. There are many methods to close the air leakages with T-M, Talc powders. Or the closure of air leakage sites can be closed c resuture, wedge resection or lobectomy through re-explothoracotomy. Tisseel, a in thoracic surgical areas in recents. We have sealed the post-operative air leakage sites after bullectomy or segmental resection for 4 recurrent spontaneous pneumothorax with the spray of Tisseel & throbin through thoracoscope without re-explothoracotomy. The post-operative courses are uneventful to now.

• Journal of Chest Surgery
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• v.28 no.1
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• pp.81-84
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• 1995

Re-expansion pulmonary edema following pneumothorax or hemothorax is clinically uncommon but occasionally life threatening. Clinical details are given of two patients.Ipsilateral pulmonary edema were developed after chest tube insertion due to spontaneous pneumothorax in case I and after evacuation of postoperative hemothorax in case II. The patients were treated with frequent bronchial toilet.The administration of colloid solution and diuretics was effective. The possible mechanisms underlying the edema are discussed.Both increased time of collapse and suction tended to correlate with reexpansion edema.The present two cases provided evidence for longstanding lung collapse and immediate application of suction.

• Journal of Chest Surgery
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• v.48 no.2
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• pp.155-155
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• 2015

• Journal of Chest Surgery
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• v.50 no.6
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• pp.424-429
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• 2017

Background: The surgical treatment of secondary spontaneous pneumothorax (SSP) can be complicated by fragile lung parenchyma. The preoperative prediction of air leakage could help prevent intraoperative lung injury during manipulation of the lung. Common sites of bulla development and ruptured bullae were investigated based on computed tomography (CT) and intraoperative findings. Methods: The study enrolled 208 patients with SSP who underwent air leak control through video-assisted thoracoscopic surgery (VATS). We retrospectively reviewed the sites of bulla development on preoperative CT and the rupture sites during VATS. Results: Of the 135 cases of right-sided SSP, the most common rupture site was the apical segment (31.9%), followed by the azygoesophageal recess (27.4%). Of the 75 cases on the left side, the most common rupture site was the apical segment (24.0%), followed by the anterior basal segment (17.3%). Conclusion: The azygoesophageal recess and parenchyma along the cardiac border were common sites of bulla development and rupture. Studies of respiratory lung motion to measure the pleural pressure at the lung surface could help to determine the relationship between cardiogenic and diaphragmatic movement and bulla formation or rupture.

• Journal of Chest Surgery
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• v.30 no.12
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• pp.1225-1231
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• 1997

Spontaneous pneumothorax is the sudden collapse of a lung usually caused by air leakage from a subvisceral pleural blob. Responses to closed thoracostomy,thoracentesls and simple observation are usually prompt and effective. But in some cases, these are unsucceful and open thoracotomy is indicated. A clinical evaluation was performed on 242 cases(236 patients) of open thoracotomy in spontaneous pneumoth rax who were admitted and treated at department of Thoracic and Cardiovascular Surgery. Masan Samsung General Hospital during the past 9 years from January 1988 to December 1996. The results were as follows 1. The sex ratio was male predominance(M:F=11.7:1) 2. The most common age group were 2nd, 3rd decades(2nd=29.3%, 3rd=30.2%). 3. The most common chief complaints were chest pain and dyspnea(chest pain=41.7%. dryspnea= 36.8). 4. The etiologic factors of spontaneous pneumothorax were primary spontaneous pneumothorax(86.4%), tuberculosis(9.1%), COPD(3.7%) and pleuritis(0.8%). 5. The site of spontaneous pneumothorax was 52.1% in right, 45.4% in left and 2.5% in both. 6. The common indications of open thoracotomy were recurrence(44.2%), persistent air leakage(31.8%) and inadequate expansion(15.7%). 7. The operative procedures were bullectomy or mechanical pleurodesis through posterolateral thoracotomy or median sternotomy. 8. The most frequent location of bulla or blob were apical segme t oi RUL(35.1%) and apicoposterior segment of LUL(41.3 %). 9. The number of bulla or blob were mainly 1 to 5(88%), and there were no significant differences among operation indications. 10. The size of bulla or bleb were mainly below 5cm(81%)and small bulla($\leq$1cm) were predominant in recurrence group but large bulla(>5cm)were predominant in persistent air leakage and inadequate expansion group. 11. The pleural adhesion was seen in 54.5%.(Recurrence group 64.1%,Persistent air leakage group 51.9%,Inadequate expansion group 47.4%).

• Journal of Chest Surgery
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• v.31 no.4
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• pp.369-373
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• 1998

The bullectomy through the limited transaxillary thoracotomy and video-assisted thoracic surgery(VATS) had been used in operative management of spontaneous pneumothorax from Jan. 1994 to July 1997. The study comprised a retrospective review of 42 cases which were treated by limited thoracotomy, and 61 cases treated by video-assisted thoracoscopic sugery. We retrospectively reviewed annual incidnce of bullectomy. Analysis of video-assised thoracoscopic surgery and open bullectomy including age, sex, operative sites, surgical indications, associated diseases, operative time, posoperatve complications and hospital courses. There was no significant difference for operation time in two groups, 98.3${\pm}$38.4 minutes in thoracotomy and 95.7${\pm}$31.5 minutes in VATS. Prolonged air leakage over 7 days was observed in 8 cases from thoracotomy group, 4 cases from VATS group. 3 cases of recurrent pneumothorax were found from VATS group, but no recurrence was occurred from open bullectomy group. There were significant differences in postoperative hospital stay (8.0${\pm}$3.9 day in thoracotomy vs 5.9${\pm}$2.4day in VATS(P=0.001)), and indwelling period of chest tube after operation( 5.8${\pm}$3.0day in thoracotomy vs 4.0${\pm}$2.0day in VATS(P=0.0006)).

• Journal of Chest Surgery
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• v.52 no.2
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• pp.91-99
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• 2019

Background: The relationship between the size of bullae and pneumothorax recurrence is controversial. The aim of this study was to retrospectively evaluate the role of blebs or bullae in predicting ipsilateral recurrence in young patients experiencing their first episode of primary spontaneous pneumothorax (PSP) who underwent conservative treatment. Methods: A total of 299 cases of first-episode PSP were analyzed. The status of blebs or bullae was reviewed on high-resolution computed tomography (HRCT). The dystrophic severity score (DSS; range, 0 to 6 points) was calculated based on HRCT. Results: The 5-year recurrence rate was 38.2%. In univariate analysis, age (<20 years), body mass index (<$20kg/m^2$), a unilateral lesion, and intermediate risk (DSS 4 and 5) were associated with recurrence. Sex; smoking history; and the presence, number, and maximal size of blebs or bullae were not related to recurrence. In Cox regression, age and intermediate risk were independent risk factors for recurrence. High risk (DDS 6) was not an independent risk factor. Conclusion: The presence, number, and size of blebs or bullae did not affect ipsilateral recurrence. DSS failed to show a positive correlation between severity and recurrence. The decision to perform surgery in patients experiencing their first episode of PSP should not be determined by the severity of blebs and bullae.

• Journal of Chest Surgery
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• v.55 no.1
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• pp.44-48
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• 2022

Background: Although classical multi-port video-assisted thoracic surgery has been widely performed, single-incision thoracoscopic surgery (SITS) is a popular surgical technique for the treatment of primary spontaneous pneumothorax (PSP). However, the inconvenient alignment of instruments and the limited field of view occasionally make surgeons convert from SITS to multi-port surgery or extend the incision. This study aimed to present an easy and safe SITS technique for PSP using a spinal needle. Methods: In total, 139 patients underwent SITS between May 2011 and December 2017. We used a spinal needle to hook the bulla or bleb, and wedge resection was performed through a small incision. Patients' medical records were reviewed retrospectively, and a telephone survey was conducted to investigate the recurrence rate. Results: The mean age of the 139 patients was 23.62±9.60 years. The mean operative time was 36.69±14.64 minutes, and multi-port conversion was not performed. The mean postoperative hospital stay was 3.00±0.78 days, and the mean indwelling chest tube duration was 1.97±0.77 days. No complications were observed. In the mean follow-up period of 86.75±23.20 months, recurrence of pneumothorax was found in 3 patients. Conclusion: We suggest that SITS for PSP with the aid of a spinal needle to replace a grasper is a safe and easy technique that only requires a small incision.

• Journal of Chest Surgery
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• v.29 no.4
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• pp.403-407
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• 1996

One hundred and twenty three patients underwent 137 thoracostomies for spontaneous pneumothorax in the department of Thoracic and Cardiovascular Surgery, Gyeongsang National University from January 1987 to December 1994. There were 118 men and 6 women and average age was )2.4 years. The two most common surgical Indications were recurrent pneumothorax and continuous air leakage. Other indications were visible bullae on simple X-ray, previous contralateral pneumothorax, incomplete expansion of the lung, and bilateral pneumothoraces. Methods of thoracotomy were subaxillary thoracotomy in 82 cases, lateral minithoracotomy in 12 cases and posterolateral thoracotomy in 43 cases. Operation time was 63.0 $\pm$ 30.8, 98.3 $\pm$ 37.9, 186.9 $\pm$ 87.9 minutes respectively, and postoperative chest tube keeping time was 5.2 $\pm$ 4.1 days in subaxillary thoracotomy, 6.2 $\pm$ 5.0 days in minithoracotomy and 10.0 $\pm$ 5.8 days in posterolateral thoracotomy Bullae were present mostly at the apex in spontaneous and tuberculous pneumothorax comparred to the cases of chronic obstructive or emphysematous lung disease, where there were no redilection of presence of bullae (p< 0.01). Operative procedures were wedge resection, bullae obliteration and lobectomy. Postoperative complications were continuous air leakage, bleeding, brachial plexus injury, empyema, and wound infection, but all the complications were cured by the time of discharge. There was no mortality.