Surgery Today

, Volume 47, Issue 9, pp 1129–1134 | Cite as

Feasibility of single-incision thoracoscopic surgery using a modified chest wall pulley for primary spontaneous pneumothorax: a propensity score matching analysis

  • Kenji TsuboshimaEmail author
  • Machiko Nagata
  • Teppei Wakahara
  • Yasumi Matoba
  • Yoshimasa Maniwa
Original Article



Recently, single-incision thoracoscopic surgery (SITS) has been recognized as a favorable treatment choice for primary spontaneous pneumothorax (PSP) compared with conventional three-port video-assisted thoracoscopic surgery (VATS). However, conventional SITS bullectomy often results in collisions with surgical devices. Therefore, we devised a method of SITS using a chest wall pulley for lung excision (PulLE) and modified PulLE (mPulLE) system, which substitutes threads to eliminate such collisions. We compared the mPulLE system with conventional procedures using propensity score matching (PSM) to adjust for patient backgrounds.


Using PSM, we evaluated the surgical results of 210 PSP patients who underwent VATS, including mPulLE (n = 23) and three-port VATS (n = 102), at our institution between January 2010 and August 2016.


We selected 17 mPulLE cases and 17 three-port VATS. There were no marked differences between the groups in the patient backgrounds or surgical results. However, there was a significant difference between the mPulLE cases and the three-port VATS cases in the operative time (71.7 ± 15.7 vs. 85.9 ± 25.5 min, respectively, P = 0.0388) and the number of autosutures used (3.6 ± 1.2 vs. 4.5 ± 1.2, respectively, P = 0.0178).


The surgical results of mPulLE in patients with PSP with multiple lesions were equivalent to those achieved with three-port VATS under the same conditions.


SITS Pulley PulLE Modified Pneumothorax 


Compliance with ethical standards


None declared.

Conflict of interest

None declared.


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Copyright information

© Springer Japan 2017

Authors and Affiliations

  • Kenji Tsuboshima
    • 1
    Email author
  • Machiko Nagata
    • 1
  • Teppei Wakahara
    • 1
  • Yasumi Matoba
    • 1
  • Yoshimasa Maniwa
    • 2
  1. 1.Department of Thoracic SurgeryTakasago Municipal HospitalTakasagoJapan
  2. 2.Division of Thoracic SurgeryKobe University Graduate School of MedicineKobeJapan

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