1. Improved Instrumentation for Effective Mechanical Pleurodesis
Presenter Information:
Rebeccah L Brown, MD
Professor of Clinical Surgery and Pediatrics
Cincinnati Children’s Hospital Medical Center
Cincinnati, OH

2. Problem Statement Pleurodesis Treatment
Patients with a pneumothorax (lung collapse) or recurring pleural effusion (accumulation of fluid in the pleural space) are commonly treated with mechanical pleurodesis - a procedure in which the parietal pleural is abraded creating an intense inflammatory response that promotes the adhesion of the visceral and parietal pleurae, effectively obliterating the pleural space, allowing the lung to fully expand
Most commonly performed thoracoscopically
Current instrumentation to achieve effective mechanical pleurodesis is limited
Improved instrumentation for performing this procedure is needed

3. Spontaneous Pneumothorax
Incidence cases per 100,000 people
More common in males than females
Usually tall, thin males < 30 years
Usually associated with subpleural blebs and bullae
Most commonly treated with thoracoscopic bleb resection and mechanical pleurodesis

4. Pleurodesis for Refractory Pleural Effusion
Allows lung to fully expand

5. Port Positioning for Thoracosopy

6. Current Instrumentation
Bovie Scratch Pad

7. Mechanical Pleurodesis
After Pleurodesis
Before Pleurodesis

8. Job: Pleurodesis Treatment
Mechanical pleurodesis is most often performed via thoracoscopy.
Usually three ports are placed - a 12 mm port for the stapler (for associated bleb resection) and two 5 mm ports.
The parietal pleura is then mechanically abraded until it is very friable and bleeding using a rough pad (usually a bovie scratch pad) held by an endoscopic grasper. Surgical removal of parietal pleura is also an effective way of achieving stable pleurodesis, however, this is less frequently performed.
Problems/limitations with the procedure
Bovie scratch pad may fracture or tear, leaving behind small fragments (foreign body)
Difficult to insert bovie scratch pad through 5 mm ports, will only fit easily through 12 mm port
Bovie scratch pad can easily fall off
With limitations of single usable port and straight, non-articulating graspers, it is difficult to reach and abrade all surfaces effectively

9. Outcomes: needed to improve procedure
Pleurodesis Treatment
Outcomes: needed to improve procedure
Difficulties to overcome
No longer use bovie scratch pad or gauze pad that is difficult to insert and remove, difficult to maneuver, can fall off grasper, has small surface area, risk of foreign body retention (pieces/fibers fracture/fall off)
Inability to effectively reach pleural surfaces due to non-articulating, non-curved instruments

10. Constraint: Device or procedure needs to
Pleurodesis Treatment
Constraint:
Device or procedure needs to
Fit into 5 mm port (ideally) – then all three ports could be utilized to reach more surface area
Articulate or curve to effectively reach all surfaces
Have enough rough surface area to be effective, efficient and easy to manipulate
No risk of foreign body retention or parts falling off into thoracic cavity

11. Concept of Articulating Scrub Head

12. Concept of Orthopedic Rasp-Like Instrumentation to Create Abrasion

13. Concept of a “Mushrooming” Head Deployed for Abrasion

14. Summary
Mechanical pleurodesis is frequently used to treat spontaneous pneumothorax and and less commonly refractory pleural effusions
Current instrumentation to achieve effective mechanical pleurodesis is limited
The ideal instrumentation would:
Fit in 5 mm ports
Articulate
Have increased rough surface area at the tip for abrasion
Have no risk of foreign body/fiber retention or parts falling off into thoracic cavity