VIDEO-ASSISTED THORACOSCOPIC SURGERY WITHOUT CHEST DRAIN PLACEMENT
DOI:
https://doi.org/10.48729/pjctvs.12Keywords:
chest drain, thoracic surgery, video-assisted thoracoscopic surgery, drainless, sympathectomy, wedge resectionAbstract
Background: Placement of chest drain following thoracoscopic procedures has been the gold standard. Nevertheless, a drainless approach may be safe and feasible in selected patients and procedures. In this study we aim to report our clinical experience after drainless video-assisted thoracoscopic surgery.
Methods: We retrospectively analyzed data of all subjects submitted to drainless video-assisted thoracoscopic surgery at our centre between January 1, 2010 and December 31, 2019. The preoperative clinical and surgical data and the immediate postoperative data were retrospectively evaluated through the consultation of the clinical processes and the computer registry system. We used descriptive statistics: mean or median, according to data distribution, and absolute or relative frequencies.
Results: We included 161 patients, mean age of 31 years (min:15; max:78). We analyzed data from patients submitted to: thoracic sympathectomy(67.1%), wedge resection, for lung biopsy, metastasis or small nodules resection (21.7%), mediastinal cysts removal (6.2%), pleural lesions resection (3.7%) and emphysematous bullae resection (1.2%). The average length of stay was 1 day. Residual pneumothorax was noted in 15 patients (9.3%). Postoperative pleural drain placement due to pneumothorax occur in 4 patients (2.5%). There was no intra-hospitalar mortality.
Conclusions: Video-assisted thoracoscopic surgery without postoperative chest drain seems to be valid and safe according to our results.
Downloads
References
Satherley, L.K., et al., Routine placement of an intercostal chest drain during video-assisted thoracoscopic surgical lung biopsy unnecessarily prolongs in-hospital length of stay in selected patients. Eur J Cardiothorac Surg, 2009. 36(4): p. 737-40.
Liao, H.C., et al., Thoracoscopic Surgery Without Drainage Tube Placement for Peripheral Lung Nodules. Ann Thorac Surg, 2020. 109(3): p. 887-893.
Cheng, K., et al., A chest tube may not necessary in children thoracoscopic lobectomy. Medicine (Baltimore), 2019. 98(26): p. e15857.
Lu, T.Y., et al., Evaluation of the necessity for chest drain placement following thoracoscopic wedge resection. Surg Today, 2017. 47(5): p. 606-610.
Ueda, K., et al., Omitting chest tube drainage after thoracoscopic major lung resection. Eur J Cardiothorac Surg, 2013. 44(2): p. 225-9; discussion 229.
Murakami, J., et al., The Validation of a No-Drain Policy After Thoracoscopic Major Lung Resection. Ann Thorac Surg, 2017. 104(3): p. 1005-1011.
Park, J.B., et al., Postoperative chest tube placement after thoracoscopic wedge resection of lung for primary spontaneous pneumothorax: is it mandatory? J Thorac Dis, 2018. 10(8): p. 4812-4818.
Watanabe, A., et al., Avoiding chest tube placement after video-assisted thoracoscopic wedge resection of the lung. Eur J Cardiothorac Surg, 2004. 25(5): p. 872-6.
Lesser, T., et al., Lung Bioposy Without Pleural Drainage. Dtsch Arztebl Int, 2019. 116(19): p. 329-334.
Brunelli, A., et al., Consensus definitions to promote an evidence-based approach to management of the pleural space. A collaborative proposal by ESTS, AATS, STS, and GTSC. Eur J Cardiothorac Surg, 2011. 40(2): p. 291-7.
Nakashima, S., et al., Feasibility and safety of postoperative management without chest tube placement after thoracoscopic wedge resection of the lung. Surg Today, 2011. 41(6): p. 774-9.
Holbek, B.L., et al., Thoracoscopic pulmonary wedge resection without post-operative chest drain: an observational study. Gen Thorac Cardiovasc Surg, 2016. 64(10): p. 612-7.
Sienel, W., et al., Early chest tube removal after video-assisted thoracoscopic surgery. Results of a prospective randomized study. Chirurg, 2005. 76(12): p. 1155-60.
Zhang, J.T., et al., Prophylactic air-extraction strategy after thoracoscopic wedge resection. Thorac Cancer, 2018. 9(11): p. 1406-1412.
Zhang, J.T., et al., Randomized Trial of an Improved Drainage Strategy Versus Routine Chest Tube After Lung Wedge Resection. Ann Thorac Surg, 2020. 109(4): p. 1040-1046.
McConaghy, J.R. and D. Fosselman, Hyperhidrosis: Management Options. Am Fam Physician, 2018. 97(11): p. 729-734.
Cerfolio, R.J., et al., The Society of Thoracic Surgeons expert consensus for the surgical treatment of hyperhidrosis. Ann Thorac Surg, 2011. 91(5): p. 1642-8.
Luckraz, H., et al., Is an intercostal chest drain necessary after video-assisted thoracoscopic (VATS) lung biopsy? Ann Thorac Surg, 2007. 84(1): p. 237-9.
Blewett, C.J., et al., Open lung biopsy as an outpatient procedure. Ann Thorac Surg, 2001. 71(4): p. 1113-5.
Holbek, B.L., et al., Fast-track video-assisted thoracoscopic surgery: future challenges. Scand Cardiovasc J, 2016. 50(2): p. 78-82.