Comparing Puncture-Detection Approaches for Manual Needle Insertions Through the Parietal Pleura

Tube thoracostomy (chest tube insertion) is a surgical procedure that treats pneumothorax, a potentially life-threatening condition where air accumulates between the chest wall and the lungs. The literature reports high complication rates for this procedure, including accidental fatality due to poor manual depth control during tool insertion. We hypothesize that an instrumented needle-holder could help operators recognize pleural puncture and improve depth control, and we present a puncture-detection experiment that contributes toward this goal. An operator manually inserted a bevel-tip needle into ex vivo porcine ribs and through the parietal pleura via a sensorized percutaneous device that records position, force, and videos. We use this rich dataset of 63 insertions to thoroughly test four previously published data-driven puncture-detection (DDPD) algorithms against two new real-time algorithms: a custom recursive digital filter with coefficients optimized for our application, and a difference equation that compares standard deviations between adjacent sliding windows. Our algorithms achieve a precision (true positives over total identified punctures) of 23% and 22%, respectively, while the precision of existing DDPD algorithms ranges from 0% to 21%. Despite these performance improvements, our results show the limitations of DDPD algorithms and motivate new methods for detecting pleural membrane punctures in thoracostomy.