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Clamshell Incision Versus Left Anterolateral Thoracotomy. Which One is Faster When Performing a Resuscitative Thoracotomy? The Tortoise and the Hare Revisited

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Abstract

Background

The clamshell incision (CI) offers a better exposure than the left anterolateral thoracotomy (LAT) as a resuscitative thoracotomy. Most surgeons will have to manage a heart wound only once or twice in their career. The patient’s survival depends on how fast the surgeon can control the heart wound; however, it is unclear which of the two incisions allows for faster control in the hands of inexperienced surgeons. The aim of this study was to compare the time needed to access and control a standardized stab wound to the right ventricle, by inexperienced surgical trainees, by LAT or CI; we hypothesized that the CI does not take longer than the LAT.

Methods

Sixteen residents were shown a video on how to perform both procedures. They were randomly assigned to control a standardized stab wound of the right ventricle on perfused human cadavers by LAT (n = 8) or CI (n = 8). Access time (skin to maximal exposure), control time (maximal exposure until control of the heart wound) and total time (the sum of access and control times) were recorded.

Results

Total time was 6.62 min [3.20–8.14] (median [interquartile range]) for LAT and 4.63 min [3.17–6.73] for CI (p = 0.46). Access time was 2.39 min [1.21–2.76] for LAT and 2.33 min [1.58–4.86] for CI (p = 0.34). Control time was 4.16 min [2.32–5.49] for LAT and 1.85 min [1.38–2.23] for CI (p = 0.018).

Conclusions

The time needed from skin incision until cardiac wound control via CI was not longer than via LAT and the easier control of the cardiac wound when using CI was confirmed.

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Acknowledgments

We would like to thank the following residents who took part at this study: Salma Alhammad, Benjamin Darnis, Kaoutar Ghammad, Xavier Giudicelli, Pierre Goubalt, Sarah Khedime, Tanguy Ledru, Thomas Leturc, Matthieu Malatray, Lorenzo Merlini, Hannah Pflieger, Maxime Polo, Melanie Quatrain, Nicolas Sigaux, Blandine Tamarelle, Adrien Van Haecke, Florence Vigouroux and Pierre-Luc Vincent.

We are also particularly grateful for the assistance given by Vanessa Nirde and Arnaud Spitzer (technicians).

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Authors and Affiliations

  1. Faculté de Médecine Lyon Est, Université Lyon 1, UMR T9405, 69003, Lyon, France

    Alexandros N. Flaris, Floran Reynard, Jean-Louis Caillot & Eric J. Voiglio

  2. Hospices Civils de Lyon, Unité de Chirurgie d’Urgence, Centre Hospitalier Lyon-Sud, 69495, Pierre-Bénite, France

    Alexandros N. Flaris, Eric R. Simms, Jean-Louis Caillot & Eric J. Voiglio

  3. Protypon Neurological-Neuromuscular Center, 79, Egnatia Street, 54635, Thessaloniki, Greece

    Alexandros N. Flaris

  4. Tulane University School of Medicine, New Orleans, LA, USA

    Eric R. Simms

  5. Institut de Recherche Biomédicale des Armées, SMCF, 91223, Brétigny sur Orge, France

    Nicolas Prat

Authors
  1. Alexandros N. Flaris
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  6. Eric J. Voiglio
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Correspondence to Eric J. Voiglio.

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Flaris, A.N., Simms, E.R., Prat, N. et al. Clamshell Incision Versus Left Anterolateral Thoracotomy. Which One is Faster When Performing a Resuscitative Thoracotomy? The Tortoise and the Hare Revisited. World J Surg 39, 1306–1311 (2015). https://doi.org/10.1007/s00268-014-2924-1

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