THORACOSCOPIC USE OF LASER IN INTRACTABLE PNEUMOTHORAX

A neodymium:yttrium, aluminum, garnet (Nd:YAG) laser was used via the instrumentation port of a standard thoracoscope for the sealing of air leaks, ablation of bullae, transection of adhesions and partial parie tal pleurectomy in 13 patients with intractable pneumothorax. The mean duration of tube thoracostomy prior to treatment was 10 days (range 4 to 21 days). All patients had intractable air leakage. Three patients had chronic lung collapse of over 50% despite adequate chest drainage . All cases were treated with thoracoscopic laser. The source of air l eakage was found to be ruptured bullae in 11 cases and a lung tear in 2 cases. In five cases the bullae were multiple. In 11 cases the air l eakage stopped within 24 h of treatment, with a single self-limiting e pisode of recurrent air leakage. In two of the cases of chronic pneumo thorax the lung failed to expand because of sizable bronchopleural fis tulae. They required thoracotomy stapling of bullae and limited thorac oplasty. The mean duration of tube thoracostomy after thoracoscopic la ser in the 11 successfully treated patients was 2.72 days (range 1 to 5 days). We conclude laser-assisted thoracoscopy is a useful therapeut ic option when treating persistent air leakage. In most cases this met hod prevents prolonged periods of tube thoracostomy and obviates thora cotomy. In cases of chronic collapse of the lung with bronchopleural f istulae this technique may not be successful.