title: A technique for visual confirmation of intrathoracic placement of tube thoracostomy using a fiberoptic laryngoscope in a cadaver.
abstract: OBJECTIVE
  Safe intrathoracic placement of chest tubes is a continual challenge. Current techniques for determining the intrathoracic location of the thoracostomy site include blunt dissection and digital exploration, with subsequent tube placement. Using current techniques, complication rates for this procedure approach 30%. We present a novel technique using available endotracheal intubation technology for determining intrathoracic placement of tube thoracostomy.
  
  
  METHODS
  One cadaver was used for placement of tube thoracostomy. Both sides of the thorax were prepared in the standard fashion for tube thoracostomy placement, and tube thoracostomy was performed on each hemithorax at interspaces 3 through 7. The right side of the thorax was used for standard thoracostomy placement, and the left side was used for fiberoptic visualization of thoracostomy placement using a video laryngoscope. Thoracic wall thickness was measured at all thoracostomy sites. Proper placement and any injuries were documented for each site.
  
  
  RESULTS
  Chest wall thickness ranged from 2.4 to 3.8 cm on the right and 2.8 to 4.0 cm on the left. With use of fiberoptic thoracostomy, no injuries were generated. During the standard thoracostomy placement in the sixth intercostal space, a pulmonary laceration was caused using blunt dissection.
  
  
  CONCLUSIONS
  Use of a fiberoptic laryngoscope offers a novel technique for direct visualization the thoracic space during tube thoracostomy. Further studies are needed to determine the safety of this technique in patients.
authors.affiliation: Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Aho
authors.forename: R K
authors.initials: RK
authors.lastname: Ruparel
authors.forename: H J
authors.initials: HJ
authors.lastname: Schiller
mesh_terms: D019985:Benchmarking; D002102:Cadaver; D015505:Chest Tubes; D019317:Evidence-Based Medicine; D006801:Humans; D020704:Laryngoscopes; D056888:Patient Positioning; D035441:Thoracic Wall / Q000601:surgery*; D013907:Thoracostomy / Q000295:instrumentation*