Use of endoscopic trocar-cannula for chest drain insertion in trauma patients and others

Background: The insertion of a chest drain into the pleural space is a common procedure used for treatment in various intrathoracic abnormalities. Recently, a new technique for chest-tube insertion for pleural cavity drainage, using the disposable endoscopic trocar-cannula, was described for the treatment of some pathologic conditions. Methods: In a prospective study, we used this technique in the treatment of patients with chest trauma, spontaneous and iatrogenic pneumothorax, and various kinds of pleural effusion. Results: One hundred twelve patients were treated by using the endoscopic trocar-cannula for tube insertion into the pleural cavity. Among them, 39 patients were treated after blunt and penetrating chest trauma. Most cannulae were of 10 to 11 mm in diameter, which enabled the insertion of large-bore drain tubes. In five trauma patients, chest-tube insertion was done successfully without antecedent chest x-ray films. The complication rate was 0.89% for intrapulmonary positioning of a chest tube in a patient who had previous ipsilateral thoracic surgery. Conclusion: The use of endoscopic trocar-cannulae for chest-tube insertion is a safe, simple, and effective technique for management of trauma and other diverse intrathoracic abnormalities. Its use outside the hospital should be further studied.