Evaluation of a Steerable Tube Thoracostomy System Compatible with a Flexible Bronchoscope

Abstract

Tube thoracostomy is effective at draining the pleural space; however, when fluid or air is loculated, drainage may be compromised. For this reason, a steerable chest tube with a redirecting stylet was developed. This tube also allows use of a flexible bronchoscope in the pleural space without significant limitations in mobility as seen in prior studies.Methods:We tested the ability of a steerable tube thoracostomy system in a porcine subject to change position, drain fluid, and utilize a flexible bronchoscope in the pleural space. Fiducial markers were implanted into the parietal pleura to demonstrate maneuverability of the bronchoscope and the ability to take forceps biopsies.Results:Bronchoscope positions in the pleural space were confirmed fluoroscopically: apical, medial, lateral, anterior diaphragm, and posterior diaphragm. All fiducial markers and tissue along the parietal pleura were located and biopsied via flexible forceps with the bronchoscope. The tube was repositioned into all dependent areas where fluid collected.Conclusions:This steerable tube and a flexible bronchoscope can access and visualize the pleural space, locate and biopsy implanted markers on the parietal pleural surface, and drain fluid from the pleural space. Further studies will be needed to evaluate the usefulness of this procedure in the clinical setting.