Page 44 - JSOM Winter 2022

FIGURE 1 Reactor device.

FIGURE 2 Reactor
technique.

National Institute of Health. Experiments were performed on
30–40 kg Sus scrofa swine by surgical residents (postgraduate
year [PGY]-2 and 3).
After intubation, intrathoracic access was established via nee-
dle catheterization in the 2nd or 3rd intercostal space. At this
point, 600mL of air was instilled into the hemithorax and
pneumothorax was confirmed with x-ray. The intervention
was randomized to surgical resident (PGY-2, -3) and technique
(OT, RT). Time was recorded. Pos-procedural radiography was
used to confirm pneumothorax resolution and tube placement.
Thoracoscopic evaluation was performed by a board-certified FIGURE 3 Reactor
thoracic surgeon to evaluate and record evidence of injury, technique.
estimated blood loss (EBL), and incision length. Radiographs
were read by a board-certified thoracic surgeon blinded to
resident and technique. After five interventions on one hemi-
thorax, the contralateral hemithorax was utilized. After 10
procedures, swine were euthanized according to local Institu-
tional Animal Care and Use Committee (IACUC) protocol.
Open Technique
The open technique was performed by making an incision su- Results
perior to the rib in the 4–6th intercostal space in the anterior
axillary line and bluntly entering the pleural space. A 28-French The results are depicted in Table 1. Fifty tube thoracostomies
chest tube was then advanced into the thorax. Chest radiogra- were performed on five swine with iatrogenic pneumothorax
phy was obtained after the tube was in position and secured. with 98% resolution rate regardless of insertion method. Ran-
Thoracoscopic evaluation was performed through a separate domization allowed for no significant difference between OT
incision by a board-certified thoracic surgeon. Incision length, and RT groups for laterality of intervention or surgical resi-
thoracic injury, tube position, and time were recorded. After dent (p = .89 and .41).
thoracoscopic evaluation, the tube was removed, and the inci-
sion was closed with suture and skin glue. Resolution
Overall, 96% of tube thoracostomies resulted in resolution
Reactor Technique of pneumothorax on post-procedural radiography. In the
The Reactor technique was performed using the device with OT group, 24/25 thoracostomies were successfully placed,
sleeve. A skin incision was made above the rib in the 4–6th with 24/25 (96%) resolving pneumothorax. In the RT group,
intercostal space in the anterior axillary line. The pleural space 25/25 thoracostomies were successfully performed, with 24/25
was entered using sequential firings of the spring-loaded Re- (96%) resolving pneumothorax. The single failed resolution in
actor device (Figure 2). The sleeve was passed over the device the OT group was the result of errant placement in the sub-
into the pleural space. The device was withdrawn, leaving the cutaneous tissue. The single failed resolution in the Reactor
sleeve in place. A 28-French chest tube was advanced through group occurred with successful entry into the pleural cavity
the sleeve (Figure 3). The sleeve was removed and the tube but incomplete evacuation of air. The size of this study (n = 50)
was secured, followed by radiographic confirmation. Thoraco- and the equal numbers of resolution between the two groups
scopic evaluation was performed, and the tube was removed. prevented evaluation of significance.
The incision was closed with suture and skin glue. Incision
length, thoracic injury, position, and time were recorded. Time
The average insertion time overall was 37.9 seconds (standard
Each insertion was evaluated by method (OT, RT), pneumo- deviation [SD] ± 14 seconds). OT average insertion time was
thorax resolution, time, incision length, placement, complica- 38.2 seconds (SD ± 10 seconds). OT maximum time (T max ) was
tions, and EBL. 63.8 seconds; minimum time (T ) was 19.3 seconds. This was
min
42 | JSOM Volume 22, Edition 4 / Winter 2022