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J Thorac Cardiovasc Surg 1995;110:273
© 1995 Mosby, Inc.

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Percutaneous thoracostomy with plastic-shielded locking trocar

Holon, Israel

From the Department of Thoracic and General Surgery, E. Wolfson Medical Center, Holon 58100, Israel.

Thoracostomy is a common procedure in trauma, general, and thoracic surgery. The traditional approach for this is insertion of a massive wire guide covered with a tube into the chest cavity. There have been many reports about injuries to organs, such as lungs, heart, and vessels, caused by the wire. This technique has therefore been controversial, and finally the ATLS committee recommended "open insertion," without a guide.

We would like to present a new, easier, and safer technique of chest tube insertion with the surgical shielded trocar. We looked for a method that combines the advantages of the two approaches, the simplicity of the wire guide and the safety of the open thoracostomy. Percutaneous thoracostomy with a locking trocar that has a plastic safety shield seems to fulfill these requirements the most.

The shielded trocar has been in use for many years in gynecologic surgery. With the development of thoracoscopic and laparoscopic techniques, it became more widely used for general and thoracic surgery. Shielded trocars are presently available in all hospitals.

After taking these factors into account, we started in our surgical department to use a surgical trocar to insert chest tubes. The technique is conducted as follows: A 1 cm incision is made with the patient under local anesthesia. A 10 mm trocar (AutoSuture, Surgiport Disposable Surgical Trocar; U.S. Surgical Corp., Norwalk, Conn.) is introduced. The trocar is equipped with a spring mechanism that allows the plastic sheath to move forward once the chest cavity has been entered by the introducer. The trocar is then removed from the introducer, and a 28F chest tube is passed into the chest cavity through the introducer. Once the tube is in place, the introducer is removed. With this technique, we have placed chest tubes in more than 100 patients who were referred to us because of pleural effusion, pneumothorax, hemopneumothorax, or empyema.

The percutaneous thoracostomy with locking trocar method has the following advantages: (1) Insertion through the chest wall is much faster and therefore less traumatic to the patient (2) The spring mechanism makes this method much safer with regard to injury to organs; no other complications were observed. (3) Percutaneous thoracotomy with locking trocar is a simple procedure that can be performed safely by less experienced staff members, for example, in emergency care. In our department, junior physicians are able to perform this procedure independently after being trained in vivo in the operating room under supervision.

We recommend this technique for routine use in chest tube insertion.

Footnotes

J THORAC CARDIOVASC SURG 1995;110:273

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This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ben Ze'ev, I. Search for Related Content PubMed PubMed Citation Articles by Ben Ze'ev, I.