Non-Invasive Removal of Tethered Surgical Drains Using Kirschner Wire with Ultrasound Guidance An In-Vitro Experimental Study

Abstract

Background. Surgical drain retention is rare but can cause significant consequences if not addressed promptly. Few studies have investigated non-invasive methods to remove tethered drains. This study aimed to determine whether tethered drains could be removed using a Kirschner wire under ultrasound guidance.

Methodology. The study was an experimental in-vitro study on pork loin specimens. Drain tubes (No. 10, No. 15) were placed subfascially with one suture stitch passing through the lumen of the drain tube (Vicryl 2-0, Vicryl 1-0). An ultrasound machine (Sonosite M Turbo) was used to locate the area of tethering. Kirschner wires (1.6 mm and 2.0 mm, threaded and smooth) were inserted and thrust multiple times intraluminally to cut the suture. There were eight possible combinations of wire type, drain diameter, and suture size with seven replicates per combination. Ultrasound accuracy was set at 0.5 cm from the tethering site, and durations were recorded with a cut-off value of five minutes.

Results. Ultrasound was able to locate the tethered site in 47 out of 56 attempts (83.93%). Most attempts (48 out of 56, 85.71%) were successful in cutting the tethered suture and removing the drain. The overall duration for drain removal was 1’35”. Shorter durations were recorded for threaded compared to smooth Kirschner wires (1’34” vs 1’37”), for size No. 10 compared to No. 15 drains (1’20” vs 1’50”), and for Vicryl 2-0 compared to Vicryl 1-0 sutures (1’25” vs 1’45”).

Conclusion. Using ultrasound to locate the area of tethering and using Kirshner wire intraluminally was an effective non-invasive way to remove tethered drains in pork loin specimens. This combined method can simplify drain removal and can be used as a first-line option before open removal.