Dry Medical Thoracoscopy with Artificial Pneumothorax Induction Using Veress Needle.

Abstract

Background: In the absence of, or minimal-volume pleural effusion, conventional medical thoracoscopy (MT) is often precluded by the risk of lung injury. Dry medical thoracoscopy (dry MT) aims to ameliorate these dangers by inducing an artificial pneumothorax via needle insufflation or blunt dissection. Veress needle is a device used by surgeons to induce pneumoperitoneum before laparoscopic surgeries, but is not commonly reported in dry MT.

Methods: We present data from a series of 31 patients in which dry MT with artificial pneumothorax induction using Veress needle were performed under thoracic ultrasonography (TUS) guidance. Procedures were deemed technically successful if all the following criteria were met: (i) successful pneumothorax induction, allowing smooth insertion of semi-rigid thoracoscope during the procedure; (ii) no immediate significant procedural-related complications; and (iii) no delayed complications such as persistent air leak, defined as leakage lasting more than 5 days necessitating prolonged chest tube placement.

Results: Complete pneumothorax induction was successful in 25 cases (80.6% technical success rate); nevertheless, biopsies were successfully performed in all cases. The most common histopathological diagnosis was malignancy (n=9, 29.0%), followed by inflammatory pleuritis (n=8, 25.8%) and tuberculosis (n=8, 25.8%). No complications were reported secondary to the procedure.

Conclusion: These findings suggest that TUS-guided dry MT with a Veress needle is technically feasible and safe in the hands of experienced MT performers who are competent in TUS.