Chest tube-free video-assisted thoracoscopic surgery secured by quantitative air leak monitoring: a case series

Abstract

Background Although chest tube-omitted video-assisted thoracoscopic surgery (VATS) has been proven to be safe and efficacious, its universal application is precluded by a varying morbidity rate due to a lack of standardization. Since digital chest drainage has already shown improved accuracy and consistency in the management of postoperative air leak, we incorporated it in the strategy of intraoperative chest tube withdrawal, aiming to achieve better results. Methods We collected the clinical data of 114 consecutive patients who underwent elective uniportal VATS pulmonary wedge resection at the Shanghai Pulmonary Hospital from May 2021 to February 2022. Their chest tubes were withdrawn intraoperatively after an air-tightness test facilitated by digital drainage: the end flow rate had to be kept ≤30 mL/min for >15 s at the setting of −8 cmH 2 O suctioning. The recordings and patterns of the air suctioning process were documented and analyzed as potential standards of chest tube withdrawal. Results The mean age of the patients was 49.7±11.7 years. The mean size of the nodules was 1.0±0.2 cm. The location of the nodules encompassed all lobes, and 90 (78.9%) patients received preoperative localization. The postoperative morbidity and mortality rates were 7.0% and 0%, respectively. Six patients had clinically overt pneumothorax and two patients had postoperative bleeding that required intervention. All of the patients recovered on conservative treatment except for one case of pneumothorax that required additional tube thoracostomy. The median length of postoperative stay was 2 days; and the median time of suctioning, peak flow rate, and end flow rate were 126 s, 210 mL/min, and 0 mL/min, respectively. The median numeric rating scale for pain was 1 on postoperative day (POD) 1 and 0 on the day of discharge. Conclusions Chest tube-free VATS assisted by digital drainage is feasible with minimal morbidity. Its strength of quantitative air leak monitoring produces important measurements for the prediction of postoperative pneumothorax and future standardization of the procedure.

Preliminary outcomes of drainless videothoracoscopic pulmonary wedge resection procedure from Turkey

“…Lesser et al used a 24F chest tube and underwater seal drainage system [ 10 ]. Li et al inserted a central venous catheter via the intercostal region at another site from the utility incision and applied -8 cm H 2 O negative pressure to the catheter [ 13 ]. Liao et al checked the air leak with saline filling to the thoracic cavity and used a 7 mm-silicon CMW drain with a vacuum ball.…”

“…While Li et al found the rate of subcutaneous emphysema to be 27.2%, Liu et al reported a very low rate of 3.3%. Additionally, they could not find any cause or predisposing factors for this complication [ 13 , 15 ]. In our series, minimal subcutaneous emphysema around the utility incision, which was detected radiologically and had no clinical significance, occurred in 4 patients, and none of them required additional intervention.…”

Editorial: Early chest drain removal following lung resection

“…Another method which was widely performed was the temporary insertion of a chest drain inside the pleural cavity (10,11,22,(24)(25)(26)(27)(28)(30)(31)(32)(33). After closing all the intra-operative chest wall incisions, the drain was subsequently either connected to a digital suction system with negative suction (24, 27, 28, 30, 31,35) or its extra-thoracic end was simply immersed to a bowl with sterile water (10,11,22,32) while the anesthetic team administered manually positive inspiratory pressures. Then if there was no air leak by both the anesthesiologist assessment of volume delivered and returned and by the digital air leak meter attached to the chest tube the chest drain was removed before extubation.…”

Assessment of Chest Tube Management Knowledge among Critical Care Nurses in a Tertiary Care Cardiac Hospital: A Descriptive Study

“…[5][6][7] Typically, these tubes remain in place post-thoracic or cardiac surgery until the output decreases to less than 150 ml in 24 hours, and any air leaks are resolved. [8][9][10] Positioned in the pleural space rather than the lungs, chest tubes are inserted between the parietal and visceral pleurae. The outer layer, the parietal pleura, covering the chest wall www.pakheartjournal.com and diaphragm, contains a small amount of serous fluid, reducing friction and enhancing pleural surface adhesion.…”