The cat-scratch procedure : a new technique for surgical management of primary spontaneous pneumothorax

Abstract

Introduction: Surgery is an option as the primary treatment for patients with primary spontaneous pneumothorax. Talc pleurodesis and subtotal parietal pleurectomy have demonstrated virtually equal effectiveness in reducing recurrence but result in significant scarring, hindering further chest access if necessary. This paper introduces a new, less invasive technique for the surgical management of primary spontaneous pneumothorax.

Methods: The procedure can easily be conducted via a uniportal thoracoscopic approach. Following the standard identification of the air leak and subsequent bullectomy, short intermittent incisions are made in the parietal pleura, each following the course of the first, second, and third ribs, respectively. Subsequently, a paravertebral block catheter and a pleural drain are inserted, completing the procedure.

Results: Five patients underwent surgery using this approach. All five were discharged without any post-operative complications and showed no signs of recurrence within 2 weeks following surgery.

Conclusion: This paper presents a new, less invasive, and less extensive form of pleurectomy for primary spontaneous pneumothorax. The primary advantage of this technique is its ability to maintain chest accessibility, especially considering that some patients with pneumothorax may require further lung surgery in the future. In addition, the procedural time is shorter, and it is expected to have a smaller negative impact on respiratory mechanics.