Talc poudrage pleurodesis

(The text is taken from the doctoral thesis of Dr Athanasios Kleontas)

After a complete clinical-laboratory, preoperative examination, the patient is taken to the operating room with the chest drainage tube already in place.

After connecting the necessary epidermal sensors and electrodes for the complete and continuous recording of the patient's vital signs and cardiorespiratory function, the patient is introduced under anaesthesia and intubated with a double lumen tracheal tube. Confirmation of good tracheal tube function, with satisfactory lung blockage of the affected hemithorax. Maintenance of anaesthesia with intravenous anaesthetic drugs and maintenance of muscle relaxation. Insertion of a triple lumen, a central venous catheter in the jugular vein, cephalad to the affected hemithorax, an arterial line in the radial artery, cephalad to the affected hemithorax and a urinary catheter in the bladder, diurethrally.

Place the patient in a lateral supine position with the affected hemithorax facing upwards and apply bed movements to sufficiently open the intercostal spaces of the affected hemithorax. Recheck and confirm that the tracheostomy tube is functioning properly, with satisfactory lung closure of the affected hemithorax.

Removal of the thoracic conduction tube, sterilization of the surgical field with a solution of povidon iodide and coating the adjacent area with aseptic screens. Initially through the pre-existing hole of the chest conduit tube (which is usually made in the front axillary line, at the height of the 5th median) and placement trocar 11mm, a thoracic examination of the affected hemispheric is carried out with thoracian camera 10mm and 30o. Usually there is minimal pleural collection, which is provided entirely by thoracic suction. Subsequently, under thoraecoscopic guidance, a 10mm hole is performed, in the middle or rear, elbow line, at the height of the 8th intermediate space. The thoracic camera is transferred to the hole of the 8th intermediate space and a thorough thoracological examination of the entire affected hemisphere is carried out. In cases of adhesions between the visceral and peripheral pleura, these are resolved thoracically with electrothermia, to full and easy re-development of the lung. In cases where there is extensive obesity, trapping part or lobe or the entire underlying lung (trapped lung), the patient should be treated with the installation of a permanent small chest conduction tube (Rocket Indwelling Pleural Catheter – IPC). Therefore, after the complete conducting of the pleural collection and congestion analysis, a temporary re-development test of the lung of the affected hemisphere is performed, with the removal of the blockage of the tracheotubular canal, which ventilated the lungs of the suffering hemissphere. Subsequently, after the successful re-development of the lung, ventilation of the lungs of the affected hemisphere is again excluded.

With the lung of the affected hemithorax in semi-expansion and the camera in the 8th intercostal space, under direct thoracoscopic view, 8gr of talc infusion is performed through the hole of the 5th intercostal space (Steritalc by Boston Medical Products S.A, France - talc poudrage), coating the entire surface of both the visceral , and mural pleura (Figures 18-19).

Image 18

Thoracoscopic image of the right hemithorax (before talc implantation)

Image 19

Thoracoscopic image of the right hemithorax (after talc implantation)

With the inoptic camera in its initial position, in the 5th intercostal space and under thoracoscopic guidance, a 28Fr chest drainage tube is placed through the hole of the 8th intercostal space, whose final position is posterior to the pulmonary portal and whose tip just exceeds the level of the azygos or semi-azygos vein. After the camera has been withdrawn, a 28Fr chest tube is inserted through the hole in the 5th intercostal space, the direction of the tube being such that its final position is anterior to the pulmonary portal and its tip reaches the dome of the mediastinum. Both tubes are fixed to the skin with Prolene suture No 0. Unblocking of the double lumen tracheal tube. Connection of the chest tubes via Y-connector to a Bülau device.

Placing the patient in the supine position, gradual reduction of anaesthesia and muscle relaxation and waking the patient in the operating room. Intubation of the patient and transfer to the metanesthetic care room. Perform portable bedside radiography and transfer the patient to the inpatient ward.

In recent years, the exact same procedure is performed with only one hole (uniportal) and without general anesthesia (combination of local anesthesia and mild sedation).