Low-cost multiport and uniport video-assisted thoracic surgery bullectomy

Abstract

Introduction
Egypt, like many other third world countries, faces a problem of rising health care cost, adding that a large number of patients are not covered by medical insurance so they have to fully pay for their health care, pneumothorax due to presence of lung bullae and blebs is a very common presentation in the emergency rooms. Video-assisted thoracic surgery bullectomy is now considered the standard procedure for treatment. We have a relatively low-cost approach for the treatment of apical lung blebs and bullae using a heavy silk suture.


Patients and methods
Between the year January 2018 and August 2020, we operated on 22 patients with primary spontaneous pneumothorax using the technique of hand ligation of blebs under multiport or uniport video-assisted thoracoscopic surgery.


Results
This study was carried out on 22 patients, comprising 59.1% male, with a mean age of 44.18 ± 14.09 years. The most frequent complaint was cough in 90.9% of the patients followed by dyspnea in 81.8% and chest pain in 63.6%. The cause of presentation was spontaneous pneumothorax in 31.8%, recurrent pneumothorax in 40.9, and lung bullae in 27.3%. The most frequent previous intervention was intercostal tube insertion (ICT) twice in 54.5% followed by ICT once in 36.4%, and finally, pigtail catheter in 9.1%. The indication of video-assisted thoracic surgery was failure of lung expansion in 59.1% followed by recurrence in 40.9%, and persistent air leak from ICT in 13.6%.


Conclusion
Our method for treatment of lung blebs and bullae using ligation via multiport or uniport offers better economic results through avoiding the use of expensive disposables, and the clinical outcomes are similar.