Minimally invasive talc insufflation: a new technique with no need for thoracoscopy

Our plain-English summary of Minimally invasive talc insufflation: a new technique with no need for thoracoscopy, by M.R. Khoshnevis, R. Geis (Journal of Bronchology & Interventional Pulmonology, 2009).

The study

• Authors: M.R. Khoshnevis, R. Geis
• Journal: Journal of Bronchology & Interventional Pulmonology
• Published: 2009;16(2):99-101
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Talc insufflation is usually performed by thoracic surgeons in the operating room through video-assisted thoracoscopic surgery (VATS) or by pulmonologists in a specially equipped suite (medical thoracoscopy). These techniques can cause postoperative pain, require placement of port sites through small incisions, and increase waiting time and cost for patients who have no need for visual inspection of the pleura, biopsy, or apical bleb resection. Poudrage (French for powdering) with asbestos-free talcum powder (talc) is a proven technique with wide acceptance for treatment of pneumothorax. Use of a small, 4 g, canister of talc under pressure is a commonly used method to aerosolize and apply it using the supplied Teflon catheters. This report describes a patient who was too ill for almost any formal procedure in whom we performed talc poudrage by an even less invasive technique, using controlled permissive pneumothorax in the radiology suite by using a small needle, guide wire, and dilator with no thoracoscopy ports. Given the increased expense, frequent waiting time delay, and diminished access to care, we believe this technique deserves consideration in patients who are poor surgical candidates and perhaps in the young patient with no computed tomography evidence that might suggest the need for apical bleb resection, biopsy, or additional investigation.

In plain English

This case report about one patient, by two physicians in Baytown, Texas, describes a medical procedure, not asbestos exposure or disease. Asbestos comes up only where the authors describe poudrage (spraying talc powder into the chest cavity) with asbestos-free talcum powder as a widely accepted treatment for a collapsed lung (pneumothorax). The patient was a 48-year-old man with metastatic colon cancer. He developed a tension pneumothorax after a subclavian port was placed, and his lung kept leaking air despite chest tubes. His advanced cancer made him a poor candidate for surgery. In the radiology department, the authors entered his chest cavity with a needle, guide wire and dilator under CT guidance. After removing the guide wire, they passed a Teflon catheter through the dilator and sprayed a standard 4-g canister of talc blindly. They used local anesthetic, sedation and no thoracoscopy ports. Afterwards the lung expanded, the patient had no pain during the procedure, and his chest x-ray and CT scan a month later were normal. The authors concluded the technique is feasible and deserves consideration in poor surgical candidates.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient) describing a new technique
• Who was studied: One 48-year-old man with metastatic adenocarcinoma of the colon with peritoneal carcinomatosis. He presented with a tension pneumothorax 1 week after placement of a subclavian port and had a persistent air leak. He was treated by authors based in Baytown, TX (San Jacinto Methodist Hospital and Baytown Chest Clinic).
• Exposure: No asbestos exposure was studied. Access to the pleural space was gained under CT guidance with a needle, guide wire and peel-away dilator. After the guide wire and obturator were removed, the Teflon catheter supplied with a standard 4-g canister of talc (Sclerosol, Bryan Corp) was passed through the dilator, and talc poudrage was performed blindly, with no thoracoscopy ports. In general terms, the article describes poudrage as using asbestos-free talcum powder.
• Main results:
  • After suction was resumed, the patient's lung expanded with adequate chest wall contact on the completion CT scan.
  • The patient remained awake and had no pain during the procedure. His oxygen saturation stayed satisfactory on nasal cannula oxygen.
  • At follow-up a month later, the patient's chest x-ray and CT scan were completely normal.
• The authors' conclusion: The authors believe the technique is feasible, less painful, less complicated, potentially less risky and less costly than conventional techniques. They state it deserves consideration in poor surgical candidates and perhaps in young patients with no CT evidence suggesting a need for apical bleb resection, biopsy or further investigation. They also state that, to their knowledge, talc poudrage without a formal port site had never been reported.

Topics

Medical terms in this study, explained in our Lexicon: Talc, Thoracoscopy, Video-Assisted Thoracoscopic Surgery (VATS), Medical Thoracoscopy, Pleura, Biopsy, Pneumothorax.

Related studies

• Minimally invasive, ionizing-free, and ultrasound-guided technique to biopsy anterior mediastinal masses: first 60 cases — B. Lorenzati, R. Cristofori, et al. (2018)
• Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy (HIPEC) by Minimally Invasive Approach, an Initial Experience — A. Arjona-Sanchez, S. Rufian-Peña, et al. (2018)
• Pleural mesothelioma: When echo-endoscopy (EUS-B-FNA) leads to diagnosis in a minimally invasive way — R. Piro, M. Fontana, et al. (2021)
• Peritoneal cystic mesothelioma treated with minimally invasive approach — G. Navarra, S. Occhionorelli, et al. (1996)
• Chemo-physical properties of asbestos bodies in human lung tissues studied at the nano-scale by non-invasive, label free x-ray imaging and spectroscopic techniques — F. Bardelli, F. Brun, et al. (2021)
• Extrapleural Pneumonectomy for Malignant Pleural Mesothelioma: A Novel Mini-Invasive Technique — F.P. Caronia, A. Fiorelli, et al. (2016)

Browse more research in Journal of Bronchology & Interventional Pulmonology, or return to medical research.