Is the trocar technique for tube thoracostomy safe in the current era?

Mohan John, Syed Razi, Sandeep Sainathan, Christos Stavropoulos

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was, 'in adult patients who require a tube thoracostomy, is the trocar technique comparable to blunt dissection in terms of rate of tube malposition or complications?' Altogether more than 258 papers were found using the reported search, of which 7 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. The articles included two retrospective reviews, three prospective observational studies and two prospective randomized studies. Of these, four papers concluded that the trocar technique was associated with a significantly higher rate of tube malposition and complications. One retrospective review found that the rate of tube malposition was similar in both groups; however, the trocar technique was abandoned due to the occurrence of severe complications like lung and stomach injury. Another study found that blunt dissection into the pleural space followed by the use of a trocar to direct the chest tube was as safe as and even more effective than blunt dissection alone. A randomized prospective study in cadavers comparing blunt vs sharp tip trocars reported that the use of blunt tip trocars resulted in less complications. We conclude that the trocar technique for chest tube placement should be avoided in adult patients as it is associated with a higher incidence of malposition and complications. The blunt dissection technique with digital exploration of the pleural cavity prior to chest tube placement is the safest technique and should be considered standard practice.

Original languageEnglish (US)
Pages (from-to)125-128
Number of pages4
JournalInteractive Cardiovascular and Thoracic Surgery
Volume19
Issue number1
DOIs
StatePublished - Jan 1 2014

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Thoracostomy
Surgical Instruments
Chest Tubes
Dissection
Prospective Studies
Pleural Cavity
Lung Injury
Cadaver
Thoracic Surgery
Observational Studies
Publications
Stomach
Outcome Assessment (Health Care)
Incidence

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Is the trocar technique for tube thoracostomy safe in the current era? / John, Mohan; Razi, Syed; Sainathan, Sandeep; Stavropoulos, Christos.

In: Interactive Cardiovascular and Thoracic Surgery, Vol. 19, No. 1, 01.01.2014, p. 125-128.

Research output: Contribution to journalArticle

John, Mohan ; Razi, Syed ; Sainathan, Sandeep ; Stavropoulos, Christos. / Is the trocar technique for tube thoracostomy safe in the current era?. In: Interactive Cardiovascular and Thoracic Surgery. 2014 ; Vol. 19, No. 1. pp. 125-128.
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