With the improvement of people’s living standard and medical progress, minimally invasive surgery has become a current development direction. Minimally invasive surgery has the advantages of small trauma and fast recovery, among which the application of lumpectomy can be said to be a milestone of minimally invasive surgery, and today we are going to talk about thoracoscopic treatment of pneumothorax and pulmonary blister. What is spontaneous pneumothorax? Each of us has 2 lungs in a normal person , called the left and right lung respectively. The lungs are located in the chest cavity and are our vital respiratory organs. The lungs are like a balloon, expanding and shrinking as we breathe, week after week. There is a small space between the lungs and the chest wall (shown on the right), medically known as the pleural cavity. Under normal circumstances, the pleural cavity is sealed, there is no gas in it, it is under negative pressure and contains only a small amount of fluid, which acts as a lubricant. If air escapes into the pleural cavity, it is called a pneumothorax; spontaneous pneumothorax is a type of pneumothorax, which is when a lung ruptures without trauma or human factors, causing gas to enter the pleural cavity. Why does spontaneous pneumothorax occur? Pneumothorax occurs mainly because of the presence of large alveoli on the surface of the lung tissue, ranging in number from one to many. The alveoli look like small, blown-up balloons with very thin walls (as shown in the diagram on the left), so they can rupture easily. Once ruptured, gas enters the chest cavity and a pneumothorax occurs. What body type is prone to spontaneous pneumothorax? Patients who are thin and tall with a flat chest are prone to spontaneous pneumothorax. The possible reason for this is that the negative pressure in the pleural cavity at the tip of the lung is relatively high, which makes it easier to form large alveoli in the long term and, therefore, to develop a spontaneous pneumothorax. What are the symptoms of spontaneous pneumothorax? The symptoms of spontaneous pneumothorax are: 1.chest pain (90%): it is the typical manifestation of spontaneous pneumothorax, often with sudden onset, the chest pain is intense at the beginning, but after a few hours, it will gradually reduce, and the pain will gradually disappear after about 24-72 hours. 2, dyspnea (80%): is another typical manifestation, dyspnea often appears in patients with more serious lung air leakage, and the lung is often compressed by > 30%. This is because after the occurrence of pneumothorax, the normal lung tissue is compressed by the gas and becomes smaller, and the respiratory function decreases causing the lack of oxygen (as shown in the picture on the right: left pneumothorax, left lung compression). The degree of dyspnea is also related to its own lung function reserve, that is to say, at the same degree of lung compression, generally, the symptoms of chest tightness are lighter in young people than in older people. 3.About 20% of patients with spontaneous pneumothorax may develop pleural effusion. Among them, a few patients are spontaneous hemopneumothorax: as pneumothorax occurs so that the lung suddenly atrophies, tearing off the adhesion bundle and blood vessels, leading to bleeding, which can lead to hemorrhage and shock in serious cases, endangering life and necessitating emergency surgery. Is spontaneous pneumothorax easy to recur? Spontaneous pneumothorax is prone to recurrence. According to statistics, the possibility of recurrence of spontaneous pneumothorax within 2 years is 30-50%, and the chance of recurrence after the second attack is 50%; the third is 62%; and the fourth is 80%. In contrast, the chance of pneumothorax recurrence after thoracoscopic treatment is less than 3%. Is there a trigger for any spontaneous pneumothorax attack? There is no specific trigger for a spontaneous pneumothorax attack: more than 80% of patients are at rest or in a state of daily life when a spontaneous pneumothorax attack occurs, and only about 9% of patients are in an exercise state. What is the treatment of choice for spontaneous pneumothorax with pulmonary alveoli? The traditional methods for treating spontaneous pneumothorax include thoracentesis and closed chest drainage, but both of these methods only promote the discharge of gas from the chest cavity and relieve the symptoms, but do not address the cause of pneumothorax – large alveoli, so they do not reduce the chance of recurrence of pneumothorax. Thoracoscopic suturing or resection of large alveoli is the preferred method for treating spontaneous pneumothorax. The advantages of thoracoscopic treatment are: 1. less trauma, less pain, and less scarring; 2. quick recovery after surgery, usually able to move on the ground on the second day after surgery, and can be removed 3-4 days after surgery; 3. precise efficacy, and less possibility of recurrence of pneumothorax after surgery. Which patients with spontaneous pneumothorax are suitable for thoracoscopic treatment? 1, spontaneous pneumothorax, recurrent attacks, more than 2 times; or after closed drainage of the chest cavity, still persistent air leakage; 2, young spontaneous pneumothorax patients, especially students, due to the relationship between further education, sports activities, etc., the first pneumothorax attack should also be operated, can reduce the psychological burden; 3, remote areas, work at height, fishermen, drivers and other special occupations, because once the attack, the risk is greater, so 4.Patients with large alveoli on both sides, once bilateral pneumothorax occurs at the same time, may be life-threatening, should also be operated, can be operated at the same time, but also in stages; 5.Great alveoli, due to compression of the surrounding normal lung tissue, even if the pneumothorax does not occur, will greatly affect lung function, should also be operated. How is the thoracoscopic surgery for spontaneous pneumothorax and large pulmonary alveoli done? First, the anesthesiologist administers general anesthesia to the patient, then the patient is placed in a lateral position and ventilated through a double-lumen tracheal tube with a single lung, which in layman’s terms means that the diseased side of the lung is artificially left unventilated and atrophied to facilitate exposure and manipulation of the surgical field. After the surgical site (axillary area) is disinfected and surgical towels are laid, the surgeon makes three incisions on the chest wall, each averaging about 2 cm and distributed in a triangle. The lowermost of these incisions is placed into a thoracoscope (similar to a camera), which magnifies the situation inside the chest cavity and transmits it to a monitor. By looking at the monitor ④, the surgeon enters the chest cavity through the other two incisions with special thoracoscopic instruments and performs the operation. The surgical operation is focused on finding large blisters (both those that have ruptured and those that have not yet ruptured) and removing them with silk sutures or with a cutting suture.