Thoracoscopy is a relatively simple and diagnostically useful procedure. Chest tube placement after medical thoracoscopy is necessary and placement of the tube in a specific location is challenging, as this is typically performed without real-time visual confirmation. A novel technique was devised to enable the placement of a chest tube under direct visualization without the need for a second port.
After performing pleuroscopy with a semi-rigid scope (Olympus, USA), a sterile Hopkins rod lens telescope (Karl Storz, Culver City, CA), was placed into the most proximal port of a twenty-eight French chest tube. The trocar was then removed, and under video guidance, the chest tube was placed through the trochar site into the costodiaphragmatic gutter and the telescope was removed from the chest tube. A second chest tube was desired and again we utilized this technique to place the other tube along the posterior thorax toward the apex of the cavity. The chest tubes were sutured in place and a post procedure chest radiograph was taken to assure the tubes remained in their desired location after the lung was fully expanded.
Two chest tubes were accurately placed under direct visual guidance into their respective desired locations without damage to surrounding structures.
A rigid telescope can be utilized to enable and confirm accurate chest tube placement.
This technique is a means of accomplishing accurate chest tube placement after thoracoscopy without increasing the risks associated with the addition of a second portal or prolonging procedure time. Future studies will investigate this method to reduce the incidence of malpositioned chest tubes inserted for other indications.
M. Zgoda, None.