Video-Assisted Thoracoscopic Blebotomy for Spontaneous Pneumothorax Treatment Using the No-knife Endoscopic Stapler

Video-Assisted Thoracoscopic Blebotomy for Spontaneous Pneumothorax Treatment Using the No-knife Endoscopic Stapler | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Video-Assisted Thoracoscopic Blebotomy for Spontaneous Pneumothorax Treatment Using the No-knife Endoscopic Stapler Sunghoon Kim, Gabriella Grisotti, Olajire Idowu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6643544/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 25 Mar, 2026 Read the published version in Pediatric Surgery International → Version 1 posted 8 You are reading this latest preprint version Abstract A standard treatment for pneumothorax due to bleb rupture is thoracoscopic blebectomy, often combined with pleurodesis to reduce recurrence risk. However, pleurodesis can cause significant postoperative pain. This study evaluates the efficacy of the no-knife endoscopic stapler blebotomy without pleurodesis using video-assisted thoracoscopic surgery (VATS) for spontaneous pneumothorax. spontaneous pneumothorax blebotomy no-knife endoscopic stapler pleurodesis thoracoscopic blebectomy video-assisted thoracoscopic surgery Figures Figure 1 Figure 2 Introduction Spontaneous pneumothorax (SP) is characterized by the accumulation of air in the pleural space, leading to lung collapse. SP is classified into two types: primary spontaneous pneumothorax, which occurs in individuals without underlying lung disease, typically young, tall, thin males who develop apical lung blebs; and secondary spontaneous pneumothorax, which appears in patients with pre-existing lung conditions such as chronic obstructive pulmonary disease, cystic fibrosis, or interstitial lung disease. Initial SP episodes can be managed with observation, oxygen therapy, aspiration of pleural air, or chest tube placement. However, surgical intervention is warranted for recurrent pneumothorax, persistent air leaks, bilateral pneumothorax, or when occupational risks (e.g., pilots, divers) make the risk of recurrence life-threatening [ 1 ]. The most common surgical treatments for SP include video-assisted thoracoscopic surgery (VATS) blebectomy, which removes the blebs responsible for the air leak, and pleurodesis, which induces an inflammatory reaction to adhere the lung to the chest wall and prevent recurrence [ 2 ]. Although effective, pleurodesis is associated with significant postoperative pain and longer recovery times. An alternative method that eliminates the need for pleurodesis could significantly reduce postoperative morbidity, and the length of stay would be reduced. This study evaluates the efficacy and safety of no-knife endoscopic stapler thoracoscopic blebotomy for treating SP. We hypothesize that if the stapled bleb lung tissue remains in situ, it will act as a natural adhesive force, causing innate pleurodesis. Methods A retrospective review was conducted on patients who underwent non-cutting endoscopic stapler VATS blebotomy for primary SP at the UCSF Benioff Children’s Hospital Oakland from 2020 to 2024. Clinical and radiological evaluations, including serial chest X-rays and pre-operative chest CT scans, confirmed SP and identified lung blebs. Patients included those with previous episodes of pneumothorax or persistent chest tube air leaks necessitating surgical intervention. The standard VATS procedure was performed as follows: Patients were placed under general anesthesia with single lung ventilation in a lateral decubitus position, affected side up. Three ports were used: one 12mm and two 5mm, with local anesthetic Ropivacaine for incisional pain control. Ports were strategically placed in the posterior lateral chest to triangulate the lung apex. Carbon dioxide insufflation at a 5-mmHg pressure further suppressed the lung. A 30-degree thoracoscope was used for visualization. Upon identifying the apical lung bleb, a no-knife endoscopic stapler (ENDOPATH ETS 45mm Articulating Linear Cutter Stapler and Staple Load: Product Code TR45W Vascular, Staple height 2.5mm, Closed Staple height 1.0mm- Ethicon Inc., Raritan, NJ, USA) was used to staple the lung tissue below the bleb, leaving the stapled tissue in situ. Multiple applications of the stapler were made for large or numerous blebs, occasionally requiring repositioning of the 12mm port. Despite being labeled a cutter, the stapler does not cut the tissue, applying six rows of staple lines. The lung apex was tested for air leaks using saline immersion, followed by placement of a 16-fr chest tube connected to Pleurovac for postoperative air leak monitoring. Daily chest X-rays were taken until chest tube removal. Port sites were closed in layers, and the patient was extubated and transferred to recovery. Outcome measures included recurrence rate, hospitalization duration measured by chest tube duration, postoperative day 1 pain levels while the chest tube was on suction as recorded by nursing staff, and any intraoperative or postoperative complications such as prolonged air leaks. Post-discharge follow-ups occurred in person at 2 weeks, then biannually by phone. Chest X-rays were obtained if patients reported dyspnea or chest pain. Ethical approval for the study was obtained from the UCSF Institutional Review Board (Study Number: 25-43439. Results The study included 10 male patients with a median age of 17 (range 15–19). The average weight of the patient was 58 kg. Two out of 10 patients had previous treatment for spontaneous pneumothorax with thoracoscopic blebectomy and pleurodesis (one had doxycycline and another had mechanical pleurodesis). Eight patients were newly diagnosed with SP. Apical blebs were identified in all patients thoracoscopically. Five patients had multiple large blebs requiring 2–3 staple cartridge use, and the remaining five had a single bleb treated with one staple fire. No intraoperative complication was observed. No patients had prolonged air leak post-operation. The median postoperative chest tube duration was 2 days (range 1–3). Over a median follow-up of 24 months (range 6–36), no recurrence of pneumothorax was documented. Patients reported minimal postoperative pain. The mean Pain Numeric Rating Scale score (0–10) on post-operative day 1 was 1.3 (range 0–4). All patients had a quick return to normal activities. Discussions Pleurodesis involves inducing an inflammatory reaction between the pleural layers, causing them to adhere and obliterate the pleural space to prevent lung collapse. It can be achieved mechanically through pleurectomy, pleural abrasion, or chemically by instilling a sclerosing agent like talc or doxycycline. Pleurodesis is highly effective in preventing pneumothorax recurrence, with a recurrence rate of 2% [ 3 ]. However, it is associated with significant postoperative pain due to pleural inflammation. Extended pain management may be required, and complications can include acute respiratory distress syndrome, infection, and chronic pleuritic pain. Additionally, extensive pleurodesis is irreversible, complicating future thoracic surgeries. This study suggests no-knife endoscopic stapler blebotomy is a safe and effective alternative for preventing recurrent pneumothorax. The technique demonstrated no recurrences over a median follow-up of 24 months, no postoperative complications, and favorable recovery metrics. Unlike cutting staplers, the no-knife stapler lays down six rows of staple lines, potentially reducing prolonged air leaks. We conjecture that the in situ bleb tissue undergoes necrosis, promoting inflammation at the chest apex and causing natural pleurodesis. The results have significant clinical implications for managing spontaneous pneumothorax, especially for young, healthy individuals with primary SP who wish to avoid the morbidity associated with painful pleurodesis. This technique may also benefit patients with complications or recurrences from traditional surgical methods. Reduced chest tube placement duration and shorter hospital stays can lead to cost savings and improved resource utilization. Enhanced recovery protocols can further improve patient outcomes and satisfaction. Exploring this technique’s use in secondary spontaneous pneumothorax and complex cases like lung reductions for emphysema could expand its applicability. While promising, this study has limitations. The retrospective design may introduce selection bias and limit the generalizability of the findings. Prospective randomized controlled trials are needed for more robust evidence of this technique’s efficacy and safety. The small sample size limits the statistical power and ability to detect rare complications or outcome differences. Larger studies with diverse patient populations are necessary to validate these results. Although the median follow-up of 24 months is adequate for short- to mid-term outcomes, longer follow-up is needed to assess the procedure’s durability and late recurrence risk. In conclusion, no-knife endoscopic stapler blebotomy represents a promising alternative to traditional methods for preventing recurrent pneumothorax. This minimally invasive technique avoids pleurodesis, reducing postoperative pain, shorter hospital stays, and favorable recovery outcomes. The absence of recurrences in our study underscores its potential effectiveness. Further research, including larger prospective studies and long-term follow-up, is warranted to confirm these findings and establish this technique as a standard treatment for spontaneous pneumothorax. Declarations Financial Disclosure: The authors have no financial relationships relevant to this article to disclose. Conflict of Interest: The authors have no conflicts of interest relevant to this article to disclose. Funding/Support: None Authors Contributions: Gabriella Grisotti analyzed and interpreted the data and helped draft the manuscript. Olajire Idowu analyzed and interpreted the data, assisted in drafting the manuscript, and critically reviewed it for important intellectual content. Sunghoon Kim conceptualized and designed the study, collected, analyzed, interpreted the data, and drafted the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work. References Speck KE, Kulaylat AN, Baerg JE et al (2023) Evaluation and management of primary spontaneous pneumothorax in adolescents and young adults: A systematic review from the APSA outcome & Evidence-based practice committee. J Pediatr Surg 58:1873–1885. https://doi.org/10.1016/j.jpedsurg.2023.03.018 Brophy S, Brennan K, French D (2021) Recurrence of primary spontaneous pneumothorax following bullectomy with pleurodesis or pleurectomy: A retrospective analysis. J Thorac Dis 13:1603–1611. 10.21037/jtd-20-3257 Cardillo G, Bintcliffe OJ, Carleo F et al (2016) Primary spontaneous pneumothorax: a cohort study of VATS with talc poudrage. Thorax 71:847–853. 10.1136/thoraxjnl-2015-207976 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 25 Mar, 2026 Read the published version in Pediatric Surgery International → Version 1 posted Editorial decision: Revision requested 08 Feb, 2026 Reviews received at journal 04 Jun, 2025 Reviewers agreed at journal 21 May, 2025 Reviewers agreed at journal 19 May, 2025 Reviewers invited by journal 19 May, 2025 Editor assigned by journal 13 May, 2025 Submission checks completed at journal 12 May, 2025 First submitted to journal 12 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6643544","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":458985507,"identity":"4e06626c-bfa4-4c55-a4d6-5c2e552dc9e9","order_by":0,"name":"Sunghoon Kim","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIiWNgGAWjYJACZjDJw9jA8AFIszcwMEgQrYVxBog+QLwWIIOHGC3yM3IPvy6osMlj4Dncutm2zc6eh4H54G0ePFoMbuSlWc84k1bMwNvYdju3LTmxh4Et2RqvFokcM2PetsOJDfyMIC0HEuwZeMyk8WmRn4GsxbLtANBh/N/wamG4kWP8GKwF5DDGtgOMPQw8bHi1GJx5Y8bMcyYtsY3nYNvNnnNAvzCzGVvOweew9hzjzzwVNon9POnPbvwoA4YYe/PDG2/wOYyBgQ0cC2xwPjN+5WAlHwirGQWjYBSMghENAJkfRoRSBdxDAAAAAElFTkSuQmCC","orcid":"","institution":"University of California San Francisco","correspondingAuthor":true,"prefix":"","firstName":"Sunghoon","middleName":"","lastName":"Kim","suffix":""},{"id":458985508,"identity":"b033173a-c88d-424d-ade5-9c93c88b4d13","order_by":1,"name":"Gabriella Grisotti","email":"","orcid":"","institution":"University of California San Francisco","correspondingAuthor":false,"prefix":"","firstName":"Gabriella","middleName":"","lastName":"Grisotti","suffix":""},{"id":458985509,"identity":"6be9bfb0-0b3e-453c-8362-7a1a6662e560","order_by":2,"name":"Olajire Idowu","email":"","orcid":"","institution":"University of California San Francisco","correspondingAuthor":false,"prefix":"","firstName":"Olajire","middleName":"","lastName":"Idowu","suffix":""}],"badges":[],"createdAt":"2025-05-12 06:53:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6643544/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6643544/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00383-026-06391-w","type":"published","date":"2026-03-25T16:13:19+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":83337419,"identity":"574f8f40-fcc9-4743-afe6-87a8930baa43","added_by":"auto","created_at":"2025-05-23 09:30:14","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":306441,"visible":true,"origin":"","legend":"\u003cp\u003eA large apical bleb is demonstrated.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6643544/v1/c3cb14f7c661855e0fe72d30.png"},{"id":83337415,"identity":"18c65061-e3e6-404c-aa66-f21b6b04ab68","added_by":"auto","created_at":"2025-05-23 09:30:13","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":157569,"visible":true,"origin":"","legend":"\u003cp\u003eA no-knife endoscopic stabler is used to perform the blebotomy. More than one firing of the stapler was needed to occlude the bleb from the lung.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6643544/v1/e7a9c745e048797fce9f9ad7.png"},{"id":105755660,"identity":"632719c3-4cfe-4cdd-95fc-319983f04d02","added_by":"auto","created_at":"2026-03-30 16:29:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":792114,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6643544/v1/a450046b-f21c-48d0-90bf-adafa19dd852.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Video-Assisted Thoracoscopic Blebotomy for Spontaneous Pneumothorax Treatment Using the No-knife Endoscopic Stapler","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSpontaneous pneumothorax (SP) is characterized by the accumulation of air in the pleural space, leading to lung collapse. SP is classified into two types: primary spontaneous pneumothorax, which occurs in individuals without underlying lung disease, typically young, tall, thin males who develop apical lung blebs; and secondary spontaneous pneumothorax, which appears in patients with pre-existing lung conditions such as chronic obstructive pulmonary disease, cystic fibrosis, or interstitial lung disease. Initial SP episodes can be managed with observation, oxygen therapy, aspiration of pleural air, or chest tube placement. However, surgical intervention is warranted for recurrent pneumothorax, persistent air leaks, bilateral pneumothorax, or when occupational risks (e.g., pilots, divers) make the risk of recurrence life-threatening [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe most common surgical treatments for SP include video-assisted thoracoscopic surgery (VATS) blebectomy, which removes the blebs responsible for the air leak, and pleurodesis, which induces an inflammatory reaction to adhere the lung to the chest wall and prevent recurrence [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Although effective, pleurodesis is associated with significant postoperative pain and longer recovery times. An alternative method that eliminates the need for pleurodesis could significantly reduce postoperative morbidity, and the length of stay would be reduced.\u003c/p\u003e \u003cp\u003eThis study evaluates the efficacy and safety of no-knife endoscopic stapler thoracoscopic blebotomy for treating SP. We hypothesize that if the stapled bleb lung tissue remains in situ, it will act as a natural adhesive force, causing innate pleurodesis.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e A retrospective review was conducted on patients who underwent non-cutting endoscopic stapler VATS blebotomy for primary SP at the UCSF Benioff Children\u0026rsquo;s Hospital Oakland from 2020 to 2024. Clinical and radiological evaluations, including serial chest X-rays and pre-operative chest CT scans, confirmed SP and identified lung blebs. Patients included those with previous episodes of pneumothorax or persistent chest tube air leaks necessitating surgical intervention.\u003c/p\u003e \u003cp\u003eThe standard VATS procedure was performed as follows: Patients were placed under general anesthesia with single lung ventilation in a lateral decubitus position, affected side up. Three ports were used: one 12mm and two 5mm, with local anesthetic Ropivacaine for incisional pain control. Ports were strategically placed in the posterior lateral chest to triangulate the lung apex. Carbon dioxide insufflation at a 5-mmHg pressure further suppressed the lung. A 30-degree thoracoscope was used for visualization. Upon identifying the apical lung bleb, a no-knife endoscopic stapler (ENDOPATH ETS 45mm Articulating Linear Cutter Stapler and Staple Load: Product Code TR45W Vascular, Staple height 2.5mm, Closed Staple height 1.0mm- Ethicon Inc., Raritan, NJ, USA) was used to staple the lung tissue below the bleb, leaving the stapled tissue in situ. Multiple applications of the stapler were made for large or numerous blebs, occasionally requiring repositioning of the 12mm port. Despite being labeled a cutter, the stapler does not cut the tissue, applying six rows of staple lines. The lung apex was tested for air leaks using saline immersion, followed by placement of a 16-fr chest tube connected to Pleurovac for postoperative air leak monitoring. Daily chest X-rays were taken until chest tube removal. Port sites were closed in layers, and the patient was extubated and transferred to recovery.\u003c/p\u003e \u003cp\u003eOutcome measures included recurrence rate, hospitalization duration measured by chest tube duration, postoperative day 1 pain levels while the chest tube was on suction as recorded by nursing staff, and any intraoperative or postoperative complications such as prolonged air leaks. Post-discharge follow-ups occurred in person at 2 weeks, then biannually by phone. Chest X-rays were obtained if patients reported dyspnea or chest pain.\u003c/p\u003e \u003cp\u003eEthical approval for the study was obtained from the UCSF Institutional Review Board (Study Number: 25-43439.\u003c/p\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe study included 10 male patients with a median age of 17 (range 15\u0026ndash;19). The average weight of the patient was 58 kg. Two out of 10 patients had previous treatment for spontaneous pneumothorax with thoracoscopic blebectomy and pleurodesis (one had doxycycline and another had mechanical pleurodesis). Eight patients were newly diagnosed with SP. Apical blebs were identified in all patients thoracoscopically. Five patients had multiple large blebs requiring 2\u0026ndash;3 staple cartridge use, and the remaining five had a single bleb treated with one staple fire. No intraoperative complication was observed. No patients had prolonged air leak post-operation. The median postoperative chest tube duration was 2 days (range 1\u0026ndash;3). Over a median follow-up of 24 months (range 6\u0026ndash;36), no recurrence of pneumothorax was documented. Patients reported minimal postoperative pain. The mean Pain Numeric Rating Scale score (0\u0026ndash;10) on post-operative day 1 was 1.3 (range 0\u0026ndash;4). All patients had a quick return to normal activities.\u003c/p\u003e"},{"header":"Discussions","content":"\u003cp\u003ePleurodesis involves inducing an inflammatory reaction between the pleural layers, causing them to adhere and obliterate the pleural space to prevent lung collapse. It can be achieved mechanically through pleurectomy, pleural abrasion, or chemically by instilling a sclerosing agent like talc or doxycycline. Pleurodesis is highly effective in preventing pneumothorax recurrence, with a recurrence rate of 2% [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, it is associated with significant postoperative pain due to pleural inflammation. Extended pain management may be required, and complications can include acute respiratory distress syndrome, infection, and chronic pleuritic pain. Additionally, extensive pleurodesis is irreversible, complicating future thoracic surgeries.\u003c/p\u003e \u003cp\u003eThis study suggests no-knife endoscopic stapler blebotomy is a safe and effective alternative for preventing recurrent pneumothorax. The technique demonstrated no recurrences over a median follow-up of 24 months, no postoperative complications, and favorable recovery metrics. Unlike cutting staplers, the no-knife stapler lays down six rows of staple lines, potentially reducing prolonged air leaks. We conjecture that the in situ bleb tissue undergoes necrosis, promoting inflammation at the chest apex and causing natural pleurodesis.\u003c/p\u003e \u003cp\u003eThe results have significant clinical implications for managing spontaneous pneumothorax, especially for young, healthy individuals with primary SP who wish to avoid the morbidity associated with painful pleurodesis. This technique may also benefit patients with complications or recurrences from traditional surgical methods. Reduced chest tube placement duration and shorter hospital stays can lead to cost savings and improved resource utilization. Enhanced recovery protocols can further improve patient outcomes and satisfaction. Exploring this technique\u0026rsquo;s use in secondary spontaneous pneumothorax and complex cases like lung reductions for emphysema could expand its applicability.\u003c/p\u003e \u003cp\u003eWhile promising, this study has limitations. The retrospective design may introduce selection bias and limit the generalizability of the findings. Prospective randomized controlled trials are needed for more robust evidence of this technique\u0026rsquo;s efficacy and safety. The small sample size limits the statistical power and ability to detect rare complications or outcome differences. Larger studies with diverse patient populations are necessary to validate these results. Although the median follow-up of 24 months is adequate for short- to mid-term outcomes, longer follow-up is needed to assess the procedure\u0026rsquo;s durability and late recurrence risk.\u003c/p\u003e \u003cp\u003eIn conclusion, no-knife endoscopic stapler blebotomy represents a promising alternative to traditional methods for preventing recurrent pneumothorax. This minimally invasive technique avoids pleurodesis, reducing postoperative pain, shorter hospital stays, and favorable recovery outcomes. The absence of recurrences in our study underscores its potential effectiveness. Further research, including larger prospective studies and long-term follow-up, is warranted to confirm these findings and establish this technique as a standard treatment for spontaneous pneumothorax.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFinancial Disclosure:\u003c/strong\u003eThe authors have no financial relationships relevant to this article to disclose.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u003c/strong\u003e The authors have no conflicts of interest relevant to this article to disclose.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding/Support:\u003c/strong\u003eNone\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contributions:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGabriella Grisotti analyzed and interpreted the data and helped draft the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOlajire Idowu analyzed and interpreted the data, assisted in drafting the manuscript, and critically reviewed it for important intellectual content.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSunghoon Kim conceptualized and designed the study, collected, analyzed, interpreted the data, and drafted the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSpeck KE, Kulaylat AN, Baerg JE et al (2023) Evaluation and management of primary spontaneous pneumothorax in adolescents and young adults: A systematic review from the APSA outcome \u0026amp; Evidence-based practice committee. J Pediatr Surg 58:1873\u0026ndash;1885. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jpedsurg.2023.03.018\u003c/span\u003e\u003cspan address=\"10.1016/j.jpedsurg.2023.03.018\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrophy S, Brennan K, French D (2021) Recurrence of primary spontaneous pneumothorax following bullectomy with pleurodesis or pleurectomy: A retrospective analysis. J Thorac Dis 13:1603\u0026ndash;1611. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.21037/jtd-20-3257\u003c/span\u003e\u003cspan address=\"10.21037/jtd-20-3257\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCardillo G, Bintcliffe OJ, Carleo F et al (2016) Primary spontaneous pneumothorax: a cohort study of VATS with talc poudrage. Thorax 71:847\u0026ndash;853. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/thoraxjnl-2015-207976\u003c/span\u003e\u003cspan address=\"10.1136/thoraxjnl-2015-207976\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"pediatric-surgery-international","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pesi","sideBox":"Learn more about [Pediatric Surgery International](http://link.springer.com/journal/383)","snPcode":"383","submissionUrl":"https://submission.nature.com/new-submission/383/3","title":"Pediatric Surgery International","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"spontaneous pneumothorax, blebotomy, no-knife endoscopic stapler, pleurodesis, thoracoscopic blebectomy, video-assisted thoracoscopic surgery","lastPublishedDoi":"10.21203/rs.3.rs-6643544/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6643544/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eA standard treatment for pneumothorax due to bleb rupture is thoracoscopic blebectomy, often combined with pleurodesis to reduce recurrence risk. However, pleurodesis can cause significant postoperative pain. This study evaluates the efficacy of the no-knife endoscopic stapler blebotomy without pleurodesis using video-assisted thoracoscopic surgery (VATS) for spontaneous pneumothorax.\u003c/p\u003e","manuscriptTitle":"Video-Assisted Thoracoscopic Blebotomy for Spontaneous Pneumothorax Treatment Using the No-knife Endoscopic Stapler","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-23 09:30:08","doi":"10.21203/rs.3.rs-6643544/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-08T16:33:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-04T16:04:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"109154138064889377479526626641151186705","date":"2025-05-21T17:44:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"33630627522544284082085335952105254139","date":"2025-05-19T23:42:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-19T14:29:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-13T05:26:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-12T14:01:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"Pediatric Surgery International","date":"2025-05-12T06:38:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"pediatric-surgery-international","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pesi","sideBox":"Learn more about [Pediatric Surgery International](http://link.springer.com/journal/383)","snPcode":"383","submissionUrl":"https://submission.nature.com/new-submission/383/3","title":"Pediatric Surgery International","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"64aeca05-20a1-42b9-9426-98282bffb79b","owner":[],"postedDate":"May 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-30T16:26:51+00:00","versionOfRecord":{"articleIdentity":"rs-6643544","link":"https://doi.org/10.1007/s00383-026-06391-w","journal":{"identity":"pediatric-surgery-international","isVorOnly":false,"title":"Pediatric Surgery International"},"publishedOn":"2026-03-25 16:13:19","publishedOnDateReadable":"March 25th, 2026"},"versionCreatedAt":"2025-05-23 09:30:08","video":"","vorDoi":"10.1007/s00383-026-06391-w","vorDoiUrl":"https://doi.org/10.1007/s00383-026-06391-w","workflowStages":[]},"version":"v1","identity":"rs-6643544","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6643544","identity":"rs-6643544","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}