The Buzdar Technique

Summary

Chest tube thoracostomy remains a lifesaving intervention in trauma and thoracic surgery, used for the management of pneumothorax, hemothorax, empyema, and pleural effusions. Despite being one of the most frequently performed procedures worldwide, complication rates remain high, ranging from 20% to 40% \[1\]. Among these, pulmonary parenchymal chest tube (PPcT) insertion represents a rare but potentially devastating event, leading to hemorrhage, air leak, bronchopleural fistula, or infection. In Pakistan, where chest trauma and pneumothorax constitute major thoracic morbidities, PPcT cases are encountered with increasing frequency but remain underreported. Current literature describes only invasive surgical approaches-such as thoracotomy or video-assisted thoracic surgery (VATS)-for PPcT removal \[9,10\], with no established minimally invasive alternatives.

In response to this clinical challenge, the Department of Thoracic Surgery at (Hospital Name), Punjab, Pakistan, has developed and implemented a novel, minimally invasive three-stage removal technique, termed the Buzdar Technique, designed to ensure safe extraction of intraparenchymal chest tubes without surgical intervention. The technique follows a standardized protocol involving:

Healing phase: Tube left in situ for approximately two weeks to allow localized fibrosis and stabilization of the lung parenchyma.

Initial retraction: Gradual 2-cm withdrawal with optional 360° rotation under radiologic and clinical supervision, followed by 24-hour observation and chest imaging.

Sequential retractions: Weekly staged retractions of 2 cm until the last fenestration exits the pleural cavity, enabling safe final removal.

This prospective cohort study, conducted from July 2025 to June 2026, aims to evaluate the safety, effectiveness, and clinical outcomes of the Buzdar Technique in managing iatrogenic PPcT. Data will include patient demographics, procedural details, complications, radiologic recovery, and overall outcomes. Success will be defined as complete tube removal without pneumothorax, air leak, bleeding, or need for surgical intervention.

Preliminary institutional experience over the past decade has shown excellent results, with minimal morbidity, no requirement for thoracotomy or VATS, and full radiologic recovery in the majority of patients. The expected outcomes of this prospective evaluation are to validate these findings, establish the Buzdar Technique as a reproducible, evidence-based approach, and contribute to the global literature on non-surgical management of PPcT.

If proven effective, this technique could represent a paradigm shift in the management of intraparenchymal chest tubes-offering a safe, staged, and minimally invasive alternative to surgical removal, particularly beneficial for centers in low- and middle-income countries where advanced surgical options may not always be available.

Conditions

• Chest Tube Management
• Chest Tube Withdrawal
• Iatrogenic Injury

Interventions

PROCEDURE

Gradual chest tube removal

Stage 1: Healing and Fibrosis Phase (2 Weeks) Once PPcT is identified, the tube is left in situ for approximately 14 days to allow localized fibrosis and sealing of the injured lung parenchyma around the tube. During this period, the patient is kept under clinical observation and radiologic monitoring (serial chest X-rays or CT scan). Antibiotic coverage is continued to prevent secondary infection, and negative pressure drainage (closed chest drainage system) is maintained to ensure pleural space healing. Stage 2: Initial Retraction and Assessment After the initial 14-day period, under sterile conditions, the chest tube is retracted approximately 2 cm. If any resistance is encountered, gentle 360° rotation of the tube is performed to free adhesions. The patient is then observed for 24 hours, during which vital signs, oxygen saturation, and drainage output are monitored. A post-retraction chest X-ray is obtained to evaluate for pneumothorax, air leak, or any evidence of lung compromise

Sponsors & Collaborators

• University of Health Sciences Lahore

  lead OTHER

Study Design

Allocation

NA

Purpose

TREATMENT

Masking

NONE

Model

SINGLE_GROUP

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2025-07-01

Primary Completion

2027-06-30

Completion

2027-09-30

Countries

• Pakistan

Study Locations