File:A-Total-Pleural-Covering-for-Lymphangioleiomyomatosis-Prevents-Pneumothorax-Recurrence-pone.0163637.s002.ogv

English: Supporitng video for TPC procedure: S1 Video shows TPC applied to the left pneumothorax in a patient with sporadic LAM (35-years-old female). The entire procedures were performed under video-assisted thoracoscopic surgery (VATS). We abridged the time greatly for short presentation. This representative procedure displays coverage of the left upper lobe’s surface. A thoracoscope turns around from the lower lobe to the upper lobe to enable examination of the entire surface of the left lung. The numerous cysts with pinkish color are easily recognized. Generally speaking, the LAM lungs are so fragile due to cystic destruction that they are easily damaged by being held with surgical forceps. Accordingly, we routinely handle them as gently as possible without actually holding them. We start TPC at the apical part of the left upper lobe by placing a sheet of ORC mesh (correspond to No. 1 of the left lung in Fig 2) and then move to the other areas in a standard order (see Fig 2). Each sheet of ORC mesh should be placed to partially overlap at the margin of adjoining sheet so that the entire lung surface is covered sufficiently with ORC meshes when the lung fully expands. Once the whole surface of left upper lobe is covered with ORC mesh, fibrin glue is applied drop by drop to spread over the covered lung surface.