Patterns, Effects, and Thoracic Volume Changes of Thoracoscopic Pleurodesis in Rabbits

Chen, Jin-Shing; Cheng, Wern-Cherng; Lien, Huang-Chun; Wu, Shu-Wei; Hsu, Hsao-Hsun; Lee, Sheng-Chung; Lee, Yung-Chie

doi:10.1016/j.jss.2007.04.033

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Volume 147, Issue 1 , Pages 34-40, 1 June 2008

Patterns, Effects, and Thoracic Volume Changes of Thoracoscopic Pleurodesis in Rabbits

Jin-Shing Chen, M.D., Ph.D.
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Wern-Cherng Cheng, M.D.
- Department of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Huang-Chun Lien, M.D.
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Shu-Wei Wu, M.S.
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Hsao-Hsun Hsu, M.D.
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Sheng-Chung Lee, Ph.D.
- Department of the Institute of Molecular Medicine, National Taiwan University, Taipei, Taiwan
Yung-Chie Lee, MD, Ph.D.
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- To whom correspondence and reprint requests should be addressed at Department of Surgery, National Taiwan University Hospital, No. 7 Chung Shan South Road, Taipei, Taiwan.

Received 19 March 2007 published online 28 July 2007.

Background

The ideal thoracoscopic pleurodesis method for preventing recurrence of spontaneous pneumothorax remains controversial. This study was conducted to compare the patterns, effects, and thoracic volume changes achieved using a variety of thoracoscopic procedures in rabbits.

Materials and methods

Thirty-six New Zealand White rabbits were randomly assigned to undergo the following thoracoscopic procedures in the left hemithorax: (a) parietal pleural abrasion; (b) minocycline instillation; (c) combination of abrasion and minocycline; or (d) examination alone. The rabbits were euthanatized 30 days after the operation to determine pleurodesis score, area of greatest adhesion, thoracic volume change, and histopathological findings.

Results

Grossly, pleural abrasion produced moderate localized apical pleural symphysis with no obvious thoracic volume change. Minocycline instillation induced moderate generalized pleurodesis with a significant decrease in thoracic volume. The combination of abrasion and minocycline instillation produced the greatest generalized pleurodesis as well as a significant decrease in thoracic volume. On microscopic examination, the combination procedure produced the greatest inflammation and fibrosis of the visceral and parietal pleura. Increased intensity of pleurodesis score as well as pleural inflammation and fibrosis is associated with decreased thoracic volume.

Conclusions

Thoracoscopic pleurodesis achieved using pleural abrasion and minocycline instillation induced different patterns of pleurodesis, and a combination of each method generated a synergy and produced a better pleurodesis. However, as the generalization and intensity of the pleurodesis were inversely associated with thoracic volume, the optimal method should be determined on an individual basis according to the clinical situation.

Key Words: pleurodesis, thoracoscopy, pneumothorax, abrasion, minocycline