Pneumothorax induction with a Boutin needle without ultrasound guidance during local anaesthetic thoracoscopy.

Pleural disease is an increasingly common presentation and local anaesthetic thoracoscopy (LAT) is becoming widely available throughout the UK. When there is little or no pleural fluid present at the time of LAT the use of a Boutin needle can decrease the number of patients requiring video assisted thorascopic surgery. All patients who underwent LAT, between October 2013-July 2017, at Royal Hampshire County Hospital were reviewed. All cases where a Boutin needle was used were identified. Each patient had a thoracic ultrasound (TUS) in the lateral decubitus position prior to the start of the LAT, lidocaine was used to anaesthetise the chest wall, alongside subcutaneous premedication. If there was little or no fluid on TUS then induction of a pneumothorax was attempted via a Boutin needle, without direct TUS. Successful induction of a pneumothorax was confirmed audibly by insufflation of air and fully inserting the Boutin needle, after the sharp introducer was removed, enabling the depth of the pneumothorax to be gauged. A total of 245 LATs were attempted; 38 (15.51%) of these had little / no pleural fluid and a Boutin needle was used, 27 (71.01%) of these were successful. Of the 20 patients biopsied mesothelioma (n=6) was the most common histological diagnosis. 10 of the failed inductions noted adhesions on TUS prior to LAT. The other (n=1, 2.63%) was stopped due to the trochar being placed into the lung, this was the only complication noted and had no subsequent sequela. A proportion of patients have little or no pleural fluid present at the time of LAT. A Boutin needle, without direct TUS, can be used successfully to induce a pneumothorax with minimal complications.