Drainless thoracoscopic surgery should be avoided in primary spontaneous pneumothorax with pleural adhesion

Abstract

Objective Drainless thoracoscopic surgery, defined by omitting chest drain after surgery, has been demonstrated to be feasible in selected patients for pulmonary resection. However, drainless procedure for the treatment of primary spontaneous pneumothorax has raised concerns for its safety and thus has been less often reported. We aimed to share our preliminary experience regarding how to select patients with spontaneous pneumothorax for this procedure. Methods A retrospective study recruiting 303 consecutive patients with the diagnosis of spontaneous pneumothorax undergoing thoracoscopic surgery in our center from August 2016 to June 2020 were done. After careful selection, the chest drain was omitted in selected patients who underwent non-intubated uniportal thoracoscopic surgery. Patients’ clinical characteristics and perioperative outcomes were analyzed. Results A total of 34 patients underwent drainless thoracoscopic surgery for the treatment of spontaneous pneumothorax. Pleural adhesion was noted in 9 patients during surgery, and all of them (100%) developed residual pneumothorax, among which intercostal drainage was required in 2 (22.2%) patients, and ipsilateral pneumothorax recurred 3 years after surgery in 1 (11.1%) patient. Among the remaining 25 without pleural adhesion, 17 (68.0%) developed minor residual pneumothorax (p = 0.006), which all resolved spontaneously within 1 to 2 weeks, with no complications or recurrence during postoperative follow-up for at least 2 years. Conclusions Drainless thoracoscopic surgery for the treatment of primary spontaneous pneumothorax is feasible but can be risky without careful patient selection. In our experience, the drainless procedure should be avoided in patients with identifiable pleural adhesion noted during surgery.

Preliminary outcomes of drainless videothoracoscopic pulmonary wedge resection procedure from Turkey

“…However, Holbek et al reported the rate of pneumothorax as 59% in their study, including 51 cases; none of the patients needed tube thoracostomy [16]. lin et al stated that pneumothorax requiring tube thoracostomy was correlated with pleural adhesion in their series including 34 cases [17]. In our study, pneumothorax was detected in 2 patients in the drainless group, and it decreased and completely resolved in follow-up radiographs.…”

“…Lin et al . stated that pneumothorax requiring tube thoracostomy was correlated with pleural adhesion in their series including 34 cases [ 17 ]. In our study, pneumothorax was detected in 2 patients in the drainless group, and it decreased and completely resolved in follow-up radiographs.…”

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

“…However, for cases with clinical pneumothorax, at least one of the three parameters exceeded the respective IQRs ( Table 4 ). Careful patient selection reduces postoperative morbidity ( 22 ). Nevertheless, due to the exploratory nature of this study, the determination of an explicit cutoff to predict postoperative morbidity was not possible, but our findings suggest that using a combination of drainage parameters rather than the flow rate alone may have a better ability to identify patients with elevated risk.…”