ND-YAG LASER PLEURODESIS VIA THORACOSCOPY - ENDOSCOPIC THERAPY IN SPONTANEOUS PNEUMOTHORAX ND-YAG LASER PLEURODESIS

From January 1986 to February 1993, 85 patients with spontaneous pneum othorax were treated in our department by a new endoscopic procedure u sing an Nd-YAG laser beam via thoracoscopy to obtain permanent pleurod esis and to treat the lung lesion responsible for the air leak. The 55 men and 30 women ranged in age from 16 to 51 years (mean age 26 years ). Under general anesthesia the thoracoscope was introduced through a l-cm incision in the anterior axillary line of the fourth intercostal space. In 68 patients small blebs (less than 2 cm in diameter) were de tected and successfully resected with low power Nd-YAG laser pulses. I n two patients found at thoracoscopy to have lesions larger than 2 cm, the Nd-YAG laser failed to seal the air leak and thoracotomy was perf ormed. Air leaks were not detected at endoscopy in the remaining patie nts. After treatment of the lung lesions, the parietal pleura was abra ded by using the laser energy. There were no side effects. Eighty pati ents were treated successfully without recurrence (maximum follow-up 8 6 months). Three other patients developed recurrence of pneumothorax a fter 5, 6, and 24 weeks, and surgery was considered mandatory in 2 of them. At thoracotomy, in both patients, a small bleb was detected in t he lower lobe and resected. The whole upper lobe was strongly adherent to the parietal pleura in the site of previous laser abrasion. The au thors conclude that Nd-YAG laser via thoracoscopy should be considered as a viable therapeutic option in patients with spontaneous pneumotho rax.