Ann Thorac Surg 2005;79:1098
© 2005 The Society of Thoracic Surgeons
Correspondence
Simultaneous Bilateral Apical Bullectomy Through Access From Only One Side
Claudio Rossella, MD,
Paolo Buniva, MD,
Alessandro Aluffi, MD,
Stefano Nazari, MD
Department of Surgery, Istituto di Ricovero & Cura a, Carattere Scientifico San Matteo, Piazza Golgi 1, 27100 Pavia, ItalyFondazione Alexis Carrel, Parco 15220080 Milan, Italy
stefanonazari{at}virgilio.it
To the Editor:
We read with interest the study by Wu and co-workers [1] reporting their successful experience with simultaneous bilateral transmediastinal treatment of spontaneous pneumothorax from apical blebs, which they performed entirely as a video-assisted mini-invasive procedure. We consider it extremely important to provide a complete solution to the clinical problem in young patients with spontaneous pneumothorax caused by bilateral apical blebs [2].
We [3] also have developed an open procedure for the same purpose, ie, simultaneous bilateral apical pleurectomy and bullectomy using access from only one side. However, we have found it easier and simpler to access the contralateral lung apex through the space between the esophagus and the first three to four thoracic vertebral bodies (Fig 1). In fact, apical bullectomy through this transmediastinal access is very simple, and it is even possible to draw the contralateral apex to the side of the hemithorax from which access was gained.
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Fig 1. The contralateral apex can be better exposed by going between the esophagus and the vertebral bodies from T-1 to T-4 (top inset) than through the anterior substernal space (lower inset). (Sx = left.)
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In our first few patients, we used the anterior substernal approach described by Wu and colleagues with the aim of extending the parietal pleurectomy. However, we found that the apex of the contralateral lung cannot be fully retracted toward the thoracotomy through this opening compared with a prevertebral access. In our more recent operations, we have limited contralateral access to the prevertebral, retroesophageal space only.
We congratulate the authors on their successful clinical achievements.
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References
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- Wu Y-C, Chu Y, Liu Y-H, Yeh C-H, Chen T-P, Liu H-P. Thoracoscopic ipsilateral approach to contralateral bullous lesion in patients with bilateral spontaneous pneumothorax. Ann Thorac Surg. 2003;76:1665–1667[Abstract/Free Full Text]
- Nazari S. Psychological implications in the surgical treatment of pneumothorax [Letter]. Ann Thorac Surg. 1997;63:1830–1831[Free Full Text]
- Nazari S, Buniva P, Aluffi A, Salvi S. Bilateral open treatment of spontaneous pneumothorax: a new access. Eur J Cardio-thorac Surg. 2000;18:608–610[Abstract/Free Full Text]
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