Low-cost biportal endoscopic surgery for primary spontaneous pneumothorax

Effect of overhang and stiffness on accessibility of catheter tip to lung defects under surgical constraints

Background

Steering a catheter tip to a defective spot on a lung during fibrin glue application under pleurography (FGAP) constitutes a very challenging task. Accurate control of tip position/slope of steerable catheters is critical for providing glue to air-leaking defects on lung during FGAP. Steerable catheters are composed of multiple segments with different flexural rigidities and experience nonlinear deformation. Therefore, predicting tip position with accuracy is difficult. The purpose of this paper is to present a novel method that can accurately control the tip of the catheter, and thus enhance its target accessibility.

Methods

The tip position of a deflected steerable catheter can be accurately predicted using a simulation tool depicting the curvature of a bent catheter based on a mechanics of materials analysis. The proposed method utilizes the simulation tool to enhance the target accessibility of the catheter’s tip. This assists medical doctors to not only select the optimal catheter prior to operation, but also to steer the catheter to the defects effectively. Simulation reliability is tested by performing a catheter deflection experiment and measuring the tip position.

Results

The simulation result accurately predicts the location of the catheter tip with an error of less than 5 mm to the experimental results.

Conclusions

Controlling pull-wire tensions and overhang lengths based on simulation results substantially improves the target accessibility of the catheter tip.

Low-cost of uniportal thoracoscopic surgery for primary spontaneous pneumothorax

Objective

Single-incision thoracoscopic surgery is a favorable treatment choice for primary spontaneous pneumothorax, and manual ligation of the bleb during thoracoscopic surgery appears to offer better economic results. In this study we undertook ligation of the bleb by hand under uniportal thoracoscopic surgery for primary spontaneous pneumothorax.

Methods

Between June 2015 and December 2016, a series of 26 patients with primary spontaneous pneumothorax underwent hand ligation of blebs using the technology of uniportal thoracoscopy, followed by pleural abrasion as necessary.

Results

No case was converted to two- or three-port video-assisted thoracoscopic surgery during the operation. No patients experienced prolonged (>5 days) air leakage. No other complication was recorded. No recurrence of pneumothorax was encountered during 29–47 months follow-up. Compared with the group treated by bullectomy using stapler, we found a significant reduction in medical costs in the group with bleb ligation.

Conclusions

Ligation of the bleb by hand under uniportal thoracoscopic surgery for primary spontaneous pneumothorax is a safe and offers better economic results, which is applicable for low income family.