File:A-Total-Pleural-Covering-for-Lymphangioleiomyomatosis-Prevents-Pneumothorax-Recurrence-pone.0163637.s003.ogv

English: Supporitng video for TPC procedure: S2 Video shows TPC applied to the left pneumothorax in a patient with sporadic LAM (35-years-old female) (the same patient with Video 1). The entire procedures were performed under video-assisted thoracoscopic surgery (VATS). We abridged the time greatly for short presentation. This representative image shows a review of coverage and final adjustment at the end of the entire procedure. After the whole surface of left lower lobe is covered according to the standard order (see Fig 2), careful observation over the whole lung surface is needed to identify if any area becomes uncovered after lung inflation, especially on the basal part of lower lobe and interlobal surface. In this patient, the apical part (S6 area, corresponding to No. 7 of the left lung in Fig 2) of the left lower lobe was partially uncovered after lung expansion. Then an additional sheet of ORC mesh is placed over the opening (the view shows an apical part of lower lobe and thoracic wall). Turning the thoracoscope to look up from the caudad to the cephalad direction confirmed that the entire lung surface is fully covered with ORC meshes (a part of lower lobe and the whole upper lobe are represented). After the fibrin glue is dropped, a chest tube is placed to complete the operation.