Even Hippocrates placed chest tubes or the history of tube thoracostomy
Chest tube placement has been performed since ancient Greek times. Early physicians, including Hippocrates himself, performed (and wrote about) the use of tube thoracostomy for the treatment of lung abscesses and empyema. Often this procedure is performed using a ‘blind approach’ based entirely on external anatomic features (intercostal spaces) and a fundamental knowledge of internal and chest wall anatomy. Over the years, surgeons have developed guidelines to this technique using palpation/ and other tactile information but none of these techniques challenged initial insertion technique.
With any blind procedure, there is a risk of inadvertent injury due to the lack of visualization, particularly in patients with previous thoracic procedures or infections (adhesions), or when performed by less experienced staff.
Direct visualization during this procedure (akin to VATS) may lessen this risk. However, little has been published on alternatives to the traditional technique.
VGTT: video-guided tube thoracostomy
Our latest post comes directly from Dr. Chih-Hao Chen at Mackay Memorial Hospital in Taiwan.
Dr. Chen presents a video clip demonstrating video-guided tube thoracostomy (VGTT), a technique used to avoid tube-related injury during the course of tube thoracostomy (versus blind insertion). This visualization technique is helpful particularly when performed by inexperienced staff, such as residents or in emergent situations.
A complete description of this technique was recently published in the Annals of Thoracic Surgery.
Chen, et. al (2013). Video-guided tube thoracostomy with use of a nonfiberoptic endoscope. Ann Thorac Surg, 2013;96: 1450-5. Articles commentary also available.
This paper describes the technique as well as discussing the clinical experience of Dr. Chen and his team in applying this technique to several patients.
Dr. Chin-Hao Chen is a thoracic surgeon at Mackay Memorial Hospital in Taiwan. Dr. Chen is a frequent and valued contributor here at Cirugia de Torax. He has provided several case studies as well as articles and videos on surgical techniques.