Cost-effective homemade automatically opening endobag for video-assisted thoracic surgery

Introduction

Video-assisted thoracoscopy has become a favoured choice in recent decades and surgical specimens often need to be extracted from the thorax during surgery. An endobag is used to facilitate such specimen removal, thus reducing the risk of wound metastasis and the loss of specimens. However, commercially available disposable endobags are expensive ¹ and most cannot open automatically. The endobag collapses during video-assisted thoracic surgery, making collection of the specimen difficult and time-consuming, especially in uniportal video-assisted thoracoscopic surgery. This article describes a novel homemade automatically opening, cost-effective, safe and easily produced endobag for video-assisted thoracic surgery.

Patients and methods

From June 2016 to August 2018, 63 patients underwent video-assisted thoracic surgery using a homemade endobag. This endobag was made of a sterile surgical glove (size 6.5, 7 or 7.5), a stainless-steel ring (6.6, 7.2 or 7.6 cm in diameter) and 1/0 silk thread (Figure 1). The stainless-steel ring was fixed at the opening of the bag with a continuous locking suture and the bottom of the bag was tied with 1/0 silk thread (Figure 2). OPEN IN VIEWER

OPEN IN VIEWER

Figure 2.

The fingers of the sterile glove were cut off and the button of the sterile glove tied using the residual 1/0 silk thread. A continuous locking suture was made at the opening of the sterile glove using the 1/0 silk thread to fix the ring.

After the homemade endobag was inserted through the thoracic port, the bag automatically opened and the specimen could easily be inserted into the bag. The intact specimen was then securely enclosed within the bag, which was pulled out with two holding forceps (Video 1 (available as online supplementary materials)).

Results

The homemade endobag was used in 63 patients who underwent various procedures: bullectomy (n = 37), lobectomy (n = 21) and mediastinal tumour resection (n = 5). All endobags remained intact after the specimens were extracted from the thoracic cavity. Extraction of specimens took approximately 3 min. No postoperative complications occurred, such as wound infection, wound metastasis or loss of glove parts within the thorax.

Discussion

Video-assisted thoracic surgery has become popular. Extraction of surgical specimens is often required and the endobag is designed to reduce the risk of wound contamination and specimen loss. However, commercially made endobags are expensive and most are not made to open automatically.

Surgical gloves have previously been used to make homemade endobags.^1,2 However, in the absence of an automatic opening mechanism, collecting specimens remains difficult. ¹ To overcome this shortcoming, oval forceps have been fixed at the opening of the surgical glove using sutures to facilitate opening and closing of the endobag during surgery. ² However, the endobag described in the present study opened automatically in the thorax because of the elasticity of the stainless-steel ring. This endobag was made of a sterile surgical glove, a stainless-steel ring and silk thread. The stainless-steel ring can be fixed with a continuous locking suture, wrapped around without sutures or fixed with an intermittent suture. However, fixing the ring by wrapping it around without sutures is not recommended because the ring sometimes breaks off. The use of an intermittent suture is also not recommended because the glove will tear easily. The continuous locking suture technique used in the present study was associated with no glove tearing or complications related to the use of sterile gloves (such as loss of glove parts in the thorax).

The stainless-steel ring can be moulded after insertion through the port, thus saving time during insertion and removal. The stainless-steel ring can also be repeatedly disinfected and re-used, thus reducing expenditure on materials. Notably, fixation of the ring with interrupted sutures is not recommended because pulling of the ring will cause the sutures to snap.

Considering the above advantages and low cost, the simple endobag described in this report is preferable to expensive commercially produced varieties.