Video-assisted thoracoscopic layered insertion of fibrin glue and polyglycolic acid sheet directly into ruptured bulla associated refractory secondary pneumothorax

Background Patients with secondary pneumothoraces generally have serious comorbid disease and poor pulmonary function and require that treatment be individualized. Though interventional treatments such as tube thoracostomy and pleurodesis are to be selected first, some cases become obstinate. Even though VATS treatment is attempted ultimately, sometimes it turned out to be inadequate for stapling or simple suturing. We present here our new VATS technique to control refractory air leak by direct infusion of fibrin glue (FG) via double lumen catheter and additional insertion of pieces of PGA (polyglycolic acid) sheet into ruptured bulla alternately.