title: Visually guided tube thoracostomy insertion comparison to standard of care in a large animal model.
abstract: BACKGROUND
  Tube thoracostomy (TT) is a lifesaving procedure for a variety of thoracic pathologies. The most commonly utilized method for placement involves open dissection and blind insertion. Image guided placement is commonly utilized but is limited by an inability to see distal placement location. Unfortunately, TT is not without complications. We aim to demonstrate the feasibility of a disposable device to allow for visually directed TT placement compared to the standard of care in a large animal model.
  
  
  METHODS
  Three swine were sequentially orotracheally intubated and anesthetized. TT was conducted utilizing a novel visualization device, tube thoracostomy visual trocar (TTVT) and standard of care (open technique). Position of the TT in the chest cavity were recorded using direct thoracoscopic inspection and radiographic imaging with the operator blinded to results. Complications were evaluated using a validated complication grading system. Standard descriptive statistical analyses were performed.
  
  
  RESULTS
  Thirty TT were placed, 15 using TTVT technique, 15 using standard of care open technique. All of the TT placed using TTVT were without complication and in optimal position. Conversely, 27% of TT placed using standard of care open technique resulted in complications. Necropsy revealed no injury to intrathoracic organs.
  
  
  CONCLUSIONS
  Visual directed TT placement using TTVT is feasible and non-inferior to the standard of care in a large animal model. This improvement in instrumentation has the potential to greatly improve the safety of TT. Further study in humans is required.
  
  
  METHODS
  Therapeutic Level II.
authors.affiliation: Department of Surgery, Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, MN, United States. Electronic address: hernandez.matthew@mayo.edu.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Hernandez
authors.affiliation: Mayo Medical School, Mayo Clinic, Rochester, MN, United States. Electronic address: vogelsang.david@mayo.edu.
authors.forename: David
authors.initials: D
authors.lastname: Vogelsang
authors.affiliation: Office of Translation to Practice, Mayo Clinic, Rochester, MN, United States. Electronic address: Anderson.Jeff1@mayo.edu.
authors.forename: Jeff R
authors.initials: JR
authors.lastname: Anderson
authors.affiliation: Department of Surgery, Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, MN, United States. Electronic address: thiels.cornelius@mayo.edu.
authors.forename: Cornelius A
authors.initials: CA
authors.lastname: Thiels
authors.affiliation: Department of Surgery, University of Minnesota, Minneapolis, MN, United States.
authors.forename: Gregory
authors.initials: G
authors.lastname: Beilman
authors.affiliation: Department of Surgery, Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, MN, United States. Electronic address: Zielinski.martin@mayo.edu.
authors.forename: Martin D
authors.initials: MD
authors.lastname: Zielinski
authors.affiliation: Department of Surgery, Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, MN, United States; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States. Electronic address: aho.johnathon@mayo.edu.
authors.forename: Johnathon M
authors.initials: JM
authors.lastname: Aho
mesh_terms: D000818:Animals; D015505:Chest Tubes; D004195:Disease Models, Animal; D011183:Postoperative Complications / Q000473:pathology; D059039:Standard of Care; D013552:Swine; D035441:Thoracic Wall / Q000473:pathology / Q000601:surgery*; D013907:Thoracostomy / Q000295:instrumentation* / Q000379:methods*
keywords: Chest tube; Trauma; Tube thoracostomy; Visual guidance