Novel Cotton Swab Compression Method for Achieving Hemostasis during Pleural Cryobiopsy under Local Anesthesia

Abstract

Introduction: Flex-rigid pleurovideoscopy for pleural biopsy under local anesthesia is a widespread substitute for thoracoscopic pleural biopsy under general anesthesia. Large, full-thickness pleural specimens are essential for improving diagnostic yield. Cryobiopsy provides a larger specimen with fewer crush artifacts but causes bleeding complications. We developed a novel hemostatic method, called the "cotton swab compression method," using a cotton swab to achieve hemostasis during pleural cryobiopsy.

Technical Report: In this procedure, a single 1.5-cm skin incision is made. After subpleural local anesthesia, the parietal pleura is incised to the endothoracic fascia using an electrocautery inserted in the same port with a pleurovideoscope. A cotton swab is inserted with the pleurovideoscope. The cryoprobe is attached to the lateral side of the incised pleura, and cryobiopsy is performed. After 6-12 seconds of freezing, the scope and cryoprobe are withdrawn slowly while observing the biopsy site. Observed bleeding is managed by compression of the biopsy site using a cotton swab. The specimen is collected while any ongoing bleeding is controlled by astriction.

Conclusions: This novel method allows for the safe collection of larger specimens with longer freezing times while only requiring cotton swabs, making it a simple and effective pleural cryobiopsy technique.