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A linear stapler with bioabsorbable polyglycolic acid felt is widely used during the resection of emphysematous lung. Currently, an improved staple device with polyglycolic acid felt is being used owing to a history of complications, such as bleeding, that was associated with the previous model. Here, we report a case of a 69-year-old man who presented to our department for treatment of left lower lobe lung cancer using the new staple device. A left lower lobectomy and emphysematous bullectomy were performed. Reoperation was performed following the diagnosis of a postoperative hemothorax. During that operation, a staple with reinforcing material was found to be in contact with the proliferating vessels on the lung surface, resulting in an active bleed. The vessel was cauterized, and the bleeding stopped. This is the first case study to report bleeding associated with the improved staple device.

We report our experience with a policy of early chest tube removal after video-assisted thoracic surgical lung biopsy (VATS-LB) in 146 patients. The chest tube (24F) was removed if four conditions were met: immediate extubation, complete expansion of the lung, drainage

A series of forty cases of traumatic hemothorax is presented. The immediate and late therapy of these cases is discussed. The following conclusions are drawn: (1) Immediate aspiration of pleural blood by thoracentesis or closed catheter drainage is recommended. The advantages of the immediate over delayed aspiration include the detection of continued bleeding and the prevention of clotted hemothorax. The fear of reinitiating bleeding by early aspiration is unfounded. (2) Postoperative hemothorax, in comparison with hemothorax due to thoracic injuries, is more likely to clot and represents a more difficult therapeutic problem. (3) The treatment of hemothorax by surgical or enzymatic decortication has an inherent, although small, risk of morbidity and mortality. (4) In selected cases, satisfactory spontaneous resolution of clotted hemothorax will occur without significant residual damage. (5) Surgical decortication will remain a valuable method for the treatment of clotted hemothorax when the conservative method of treatment is not applicable.

TRAUMATIC or postoperative hemothorax should be evacuated early to approximate the pleural surfaces, preserve pulmonary function, and obviate the need for surgical decortication.1There is always the possibility that clotting will take place despite early attempts at aspiration. Massive clotting has been reported as occurring in from four to six hours. Fibroblastic organization may begin as early as the fifth day. Experience in World War II indicated that from 15 to 20% of hemothoraces clot.2Organizing hemothorax occurs less frequently in civilian practice. The lysis and aspiration of a clotted hemothorax by means of an enzymatic agent would be desirable. The intrapleural injection of crystalline trypsin has been shown to produce only minimal pleural and systemic effects in animals.3The proteolytic properties of trypsin are also well known.4 Experiments were conducted to determine the effectiveness of trypsin in the closed treatment of clotted hemothorax and also