New technologyVideo-Guided Tube Thoracostomy With Use of an Electrical Nonfiberoptic Endoscope
Section snippets
Technology
To effectively guide the tube, the guiding device must be very small. We designed an independent image-obtaining device, similar to the electrical nonfiberoptic endoscope (ENFE) that we reported in a previous study [1]. The basic component of this device is a complimentary metal-oxide semiconductor image sensor with a resolution of 640 × 480 pixels and horizontal/vertical viewing angles of 60°. The refresh rate was 30 frames per second, and the focus was adjusted to a range of 3 to 7 cm for
Technique
The execution of the basic procedure was very straightforward. The patient was placed in a lateral decubitus position for better exposure of the operative field; alternatively, the patient was allowed to choose a comfortable supine or slightly tilted position. We routinely administered intravenous analgesics. The operative field was then prepared, disinfected with 2% chlorhexidine or iodine solution, and subsequently covered. After local anesthetics were given subcutaneously, a small incision
Clinical Experience
After patient evaluation, the presence of pleural adhesion was our main reason for choosing the video-guided tube thoracostomy technique over the conventional blind method. Six highly selected patients underwent the procedure. Their clinical data are shown in Table 1. The components of the device were disinfected by ethylene oxide as a standard preparation for medical devices. Here, we briefly describe two cases.
The first case was a rare condition of anorexia nervosa with resultant spontaneous
Comment
Adverse events arising from tube thoracoscostomy are not uncommon. They include a malpositioned and kinked tube and direct injury to the diaphragm (Fig 5A) and lung, resulting in bronchopleural fistula (Fig 5B). One reason for these adverse events is that the physician is unable to properly obtain a front image view of the chest cavity. Therefore, when the tube is improperly and forcefully inserted into the tissues, the procedure can be extremely dangerous. Although uncommon, cases of massive
Disclosures and Freedom of Investigation
The authors received no external funding and bought the complimentary metal oxide semiconductor modules and chips from NewKen Technology Inc. Design and assembly were performed by the authors and by UniMax Ltd. All authors had full control of the design of the study, methods used, outcome parameters, analysis of data and production of the written report.
References (3)
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A preliminary report of a disposable electrical non-fiberoptic endoscope in thoracoscopic surgery
Int J Surg
(2012)
Cited by (6)
Video-tube thoracostomy in trauma resuscitation: A pilot study
2019, InjuryCitation Excerpt :The use of a rigid 32 F thoracic tube as a guide for a semi-flexible fiberoptic thoracoscope rather than using a rigid thoracoscope for the diagnosis, inspection, and management of patients with pleurisy has also been described [11]. Chen et al. observed a variation of direct visualization with the use of an electrical non‐fiberoptic endoscope and suggested that visually guided TT may be a safer alternative than non‐image guided TT in cases of pleural adhesions [12]· Optimal tube placement for evacuation of a simple pneumothorax has been found to be an apical and anterior position whereas for fluid drainage a dependent tube position at the posterior base is associated with better success rate in fluid drainage.
Visually guided tube thoracostomy insertion comparison to standard of care in a large animal model
2017, InjuryCitation Excerpt :TTVT placement is a potential adjunct for the safe and reliable insertion of TT potentially by all providers [20,21]. Image guidance may increase the operator’s tactile sense during TT insertion and reduce complications often incurred during blind insertion [22]. TTVT placement has the potential to be a major advancement for management of intrathoracic pathology compared to the standard of care in tube thoracostomy but this needs to be assessed through clinical study.
Application of wireless electrical non-fiberoptic endoscope: Potential benefit and limitation in endoscopic surgery
2015, International Journal of SurgeryCitation Excerpt :At times, we need to drain pleural effusion in a patient who has pleural adhesion. Direct tube thoracostomy may cause unexpected lung injury [1,12]. If we can see the internal structure and then place the tube, unexpected injury may be avoided.
Invited commentary
2013, Annals of Thoracic SurgeryComparison of a novel, endoscopic chest tube insertion technique versus the standard, open technique performed by novice users in a human cadaver model: A randomized, crossover, assessor-blinded study
2018, Scandinavian Journal of Trauma, Resuscitation and Emergency MedicineA preliminary report on the feasibility of single-port thoracoscopic surgery for diaphragm plication in the treatment of diaphragm eventration
2013, Journal of Cardiothoracic Surgery
Disclaimer
The Society of Thoracic Surgeons, the Southern Thoracic Surgical Association, and The Annals of Thoracic Surgery neither endorse nor discourage use of the new technology described in this article.