Novel air leak test using surfactant for lung surgery

Area of Science:

• Thoracic Surgery
• Surgical Innovation
• Pulmonary Medicine

Background:

• Prolonged air leak is a common postsurgical complication after pulmonary resection.
• The traditional water submersion test (WST) for air leaks is cumbersome during video-assisted thoracic surgery (VATS).
• A need exists for a VATS-compatible air leak detection method.

Purpose of the Study:

• To develop a novel, VATS-compatible method for detecting air leaks.
• To identify an optimal surfactant solution for visualizing air leaks during thoracic surgery.

Main Methods:

• Utilized ex-vivo porcine lung experiments to test various liquid surfactants.
• Assessed bubble formation and visibility through a thoracoscope under ventilated conditions.
• Optimized surfactant concentration and formulation for clear air leak detection.

Main Results:

• Pluronic F-127 (PF127) demonstrated promising bubble-forming properties.
• A 15% PF127 solution, colored with indocyanine green, provided optimal bubble size and dynamic visibility.
• Concentrations above 20% PF127 caused excessive viscosity and obscured vision; 10% PF127 was ineffective.

Conclusions:

• A 15% PF127 bubble solution is effective for detecting small air leaks in VATS.
• The solution enhances visualization in limited surgical fields.
• Further clinical verification of safety is required for widespread adoption.