Protection of the mediastinum and chest wall with an artificial pneumothorax during lung ablations.

The objective in creating an artificial pneumothorax during lung ablation is to develop a working space in the thorax sufficient to displace the target lung lesion from adjacent vulnerable mediastinal or chest wall structures. Attempts to induce a protective pneumothorax with the use of spring-loaded needles were successful in four of six patients, permitting development of safe "windows" for ablation. These pneumothoraces were induced by the introduction of a needle with a spring-loaded, blunt-tipped obturator into the pleural space, followed by injection of room air. Pleural adhesions related to previous interventions may interfere with creation of a pneumothorax. Use of this technique could extend the utility of ablative therapies for lesions adjacent to the mediastinum and chest wall.