Leveling the playing field: A pressure-sensing trocar improves speed and accuracy in tube thoracostomy

BACKGROUND: Tube thoracostomy is performed over one million times annually in the United States, including ~300,000 emergent procedures often without imaging guidance. Conventional open techniques carry complication rates of 25% to 30%, largely due to malpositioning. ThoraSET (Thoracic Safety Enhancing Trocar) is a pressure-sensing trocar system that differentiates tissue layers and provides real-time visual feedback. We hypothesized that ThoraSET would improve placement accuracy and reduce placement time, narrowing the gap between novice and expert users. METHODS: This prospective study combined iterative device development with stakeholder feedback and comparative evaluation on porcine cadaver and mannequin models. Participants across four experience levels (novices, residents, APPs, attending surgeons) completed paired open and ThoraSET-assisted tube thoracostomy trials. Primary outcomes were placement time and anatomical accuracy. Paired t tests and McNemar or exact McNemar tests were used for analysis, with sensitivity analyses by model type. RESULTS: Among 25 participants, ThoraSET reduced placement time for novices (-62%), residents (-26%), and APPs (-43%), but increased time for attendings (+33%). Large effect sizes were observed for novices and APPs. Overall accuracy was higher with ThoraSET (79% vs. 54%; P=0.07). Residents' accuracy improved from 10% to 80%; APPs and attendings remained 100%; novices decreased from 50% to 25%. Sensitivity analyses confirmed similar trends, with significant time reductions on pig (p=0.038, d=-0.57) and mannequin models (P=0.028, d=-0.73). CONCLUSIONS: ThoraSET improved placement speed and accuracy, particularly among less experienced users, and may reduce procedural variability and complications. Its mechanically responsive, blunt trocar provides tactile feedback, enhanced control, and intrathoracic access, supporting safer placement and use of smaller, softer tubes. These pilot results suggest ThoraSET has the potential to elevate safety and standardization in emergency and trauma care, warranting further clinical validation. (J Trauma Acute Care Surg. 2026;00: 000-000.). LEVEL OF EVIDENCE: Therapeutic/Care Management; Level V.