RED Protocol: Ultrasound for Intraoperative Detection of Pneumothorax and Hemothorax in Rib Remodeling Surgeries

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ID: 337804
2026
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Abstract
BACKGROUND: Ribcage remodeling procedures are increasingly used in aesthetic surgery to reduce waist circumference; however, they carry a potential risk of pneumothorax and hemothorax due to proximity to the lung parenchyma. Early intraoperative detection of these complications is critical but currently not standardized. OBJECTIVES: To evaluate the feasibility and diagnostic performance of the Rib Complication Evaluation and Detection (RED) protocol, an intraoperative ultrasound-based approach for detecting pneumothorax and hemothorax during ribcage remodeling procedures. METHODS: A retrospective observational study was conducted including 113 patients undergoing ribcage remodeling between 2023 and 2024. Due to the low incidence of pneumothorax, the protocol was additionally assessed using 250 high-fidelity simulation scenarios with the CAE Vimedix system. Ultrasound findings were standardized, and sensitivity, specificity, and predictive values were calculated. RESULTS: No cases of pneumothorax or hemothorax were identified in the clinical cohort. In simulation testing, the RED protocol demonstrated a sensitivity of 96% and specificity of 100% for pneumothorax detection, with a positive predictive value of 100% and a negative predictive value of 98%. The protocol successfully differentiated pneumothorax from other thoracic conditions. CONCLUSIONS: The RED protocol provides a structured and reproducible approach for intraoperative lung ultrasound in ribcage remodeling. While simulation was necessary due to the low prevalence of complications, the protocol is based on well-established sonographic signs. Its high negative predictive value suggests utility as a rule-out tool, enhancing intraoperative safety. Further prospective studies are needed to validate its performance in real clinical scenarios.
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Authors Hugo A. Aguilar, Manuel Velasco, Luis Felipe Reyes, Nicole G. Echeverry, Alfredo E. Hoyos, Silvia J Villabona, Hector M Serrano, Ricardo Proto, Daniel Oñate Valdivieso, Carlos Oñate Valdivieso, Cristian J Diaz, William Peña-Pinzón, Mauricio E. Perez, Agustina Varela, Brian Ramírez
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Journal Aesthetic surgery journal
Year 2026
DOI
10.1093/asj/sjag245
URL
https://doi.org/10.1093/asj/sjag245
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