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Derek P. Nathan, MD, Nyali E. Taylor, MD, MPH, David W

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Presentation on theme: "Derek P. Nathan, MD, Nyali E. Taylor, MD, MPH, David W"— Presentation transcript:

1 Thoracoscopic Total Parietal Pleurectomy for Primary Spontaneous Pneumothorax 
Derek P. Nathan, MD, Nyali E. Taylor, MD, MPH, David W. Low, MD, Daniel Raymond, MD, Joseph B. Shrager, MD  The Annals of Thoracic Surgery  Volume 85, Issue 5, Pages (May 2008) DOI: /j.athoracsur Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

2 Fig 1 (A) Rubbing in the anterior first interspace causes the pleura to separate from the endothoracic fascia; the arrow indicates the subclavian artery. (B) The free edge of the pleura is grasped and placed under tension to progressively separate it from the chest wall. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

3 Fig 2 The pleurectomy from anterior chest wall has now progressed as far caudally as fifth interspace; the small arrow indicates the cut edge of the pleura and the large arrow indicates the mammary vessels. Note that mammaries are protected by taking pleurectomy only as far as shown. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

4 Fig 3 Initial stage of pleurectomy from posterior chest wall, showing leading edge of the pleura in this instance grasped through posterior incision while additional traction is exerted with ball-sponge through anterior incision; the small arrow indicates the line to which the pleurectomy will be taken and the large arrow indicates the sympathetic chain. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

5 Fig 4 The artist's depiction (right-sided operation) of technique and extent of dissection when one has completed posterior and is beginning anterior dissection. Note that pleura is maintained intact over sympathetic chain, mediastinum and far-medial apex adjacent to mediastinum. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

6 Fig 5 The “spaghetti method” of rolling up pleura as it separates from endothoracic fascia. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

7 Fig 6 The completed pleurectomy; the small arrow indicates the cut edge of the pleura and the large arrow indicates the apex. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

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