New technology
Video-Guided Tube Thoracostomy With Use of an Electrical Nonfiberoptic Endoscope

https://doi.org/10.1016/j.athoracsur.2013.06.098Get rights and content

Purpose

Tube thoracostomy is a common and generally safe procedure. However, potential hazards can occur during placement of the chest tube. Inasmuch as unexpected injuries may arise from tube thoracostomy, we propose a novel video-guided method.

Description

We used an independent complementary metal oxide semiconductor image sensor with a processing chip to obtain a front view image of the chest cavity. The device is connected to an aluminum shaft with four small light-emitting diode crystals in the tip, and a detachable small monitor with a battery inside. The apparatus is small and can be used to direct vision-guided tools in tube thoracostomy.

Evaluation

We performed video-guided tube thoracostomy in 6 patients with pleural adhesions. All patients experienced good tolerance to the procedure and had no immediate adverse events. The thoracostomies were performed by a single surgeon with good acceptability, and each procedure was completed in less than 10 minutes.

Conclusions

In some cases of pleural adhesion, the video-guided thoracostomy may be a safer alternative to non–image guided tube thoracostomy.

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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    2019, Injury
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    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, Injury
    Citation 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 Surgery
    Citation 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 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.

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