The "loop" technique for primary spontaneous pneumothorax: A retrospective study of 18 patients

Background: Primary spontaneous pneumothorax (PSP) is a well-known disease but with multiple different surgical approaches. The objective of our study is to present the results of an innovative minimal uniportal approach for patients with such a disease. This will be able to reduce postoperative pain simultaneously considering the cosmetic problems of otherwise 'healthy' patients. Methods: We retrospectively evaluated the surgical results of 18 patients who underwent single incision thoracoscopic surgery (SITS) using a loop at our institution between January 2015 and August 2016. Single access of 20 mm was done at the level of the 8th intercostal space. We used a 'loop' of a non-absorbable braided suture inserted through the IV intercostal space to isolate and suspend any dystrophic area to resect. In every patient, the pulmonary ligament was dissected and pleurodesis done with pleural abrasion. Results: We had no complications after SITS. The mean operative time for SITS was 55±7.36 (standard deviation) minutes. Usually, the chest tube is removed in the 2nd postoperative day, and the patient discharged the day after. There were no conversions from SITS to three-port VATS or thoracotomy. Nobody reported chronic pain and paraesthesia. No patients had an ipsilateral recurrence of pneumothorax in the 2 years after surgery. Conclusions: The operation we propose is safe and easily reproducible. Considering the small number of patients, this technique offers excellent results regarding the duration of recovery, postoperative pain and paraesthesia, without increasing the risks of complications for the patient and the costs of surgery.