Evaluation of the necessity for chest drain placement following thoracoscopic wedge resection

Abstract

PurposeTo evaluate the outcomes of patients who underwent thoracoscopic wedge resection without chest drain placement.MethodsThe subjects of this retrospective study were 89 patients, who underwent thoracoscopic wedge resection at our hospital between January, 2013 and July, 2015. A total of 45 patients whose underlying condition did not meet the following criteria were assigned to the “chest drain placement group” (group A): peripheral lesions, healthy lung parenchyma, no intraoperative air leaks, hemorrhage or effusion accumulation, and no pleural adhesion. The other 44 patients whose underlying condition met the criteria were assigned to the “no chest drain placement group” (group B). Patient characteristics, specimen data, and postoperative conditions were analyzed and compared between the groups.ResultsGroup A patients had poorer forced expiratory volume in one second (FEV1) values, less normal spirometric results, significantly higher resected lung volume, a greater maximum tumor-pleura distance, and a larger maximum tumor size. They also had a longer postoperative hospital stay. There was no difference between the two groups in postoperative complications.ConclusionsAvoiding chest drain placement after a thoracoscopic wedge resection appears to be safe and beneficial for patients who have small peripheral lesions and healthy lung parenchyma.

Biopsia pulmonar por minitoracotomía. ¿Es necesario el drenaje pleural?

“…Existen pocos reportes de realizar un procedimiento abierto sin colocación de drenaje torácico en resecciones lingulares. 16 Común-mente las publicaciones de resección en cuña e incluso lobectomías sin tubo torácico sin complicaciones severas se refieren a los realizados por videotoracoscopia, con las ventajas de menos dolor, pequeñas incisiones y menor trauma, 17,18 y su uso innecesario incrementa la estadía hospitalaria sin reducción de la incidencia de neumotórax. 19 Del total de biopsias pulmonares por minitoracotomía, decidimos no dejar drenaje pleural en aquellos pacientes que cumplieran los siguientes criterios: a) pulmones de consistencia blanda, b) expansibilidad adecuada, c) adherencias pleuropulmonares laxas o inexistentes, d) sin engrosamiento pleural, e) no fugas aéreas observadas a maniobras de Valsalva mientras se vierte agua en la línea de sutura y f) ausencia de derrame pleural.…”

It is safe and feasible to omit the chest tube postoperatively for selected patients receiving thoracoscopic pulmonary resection: a meta-analysis

“…A number of clinical trials have been conducted to explore the feasibility and safety of omitting chest tube after pulmonary surgery, and found that NCT after pulmonary does not increase the morbidity and mortality, and meanwhile decrease the pain scale postoperatively. Some institutions have made efforts to explore the benefits of NCT especially for small pulmonary nodules underwent VATS wedge (5)(6)(7)9,10,24). At the same time, a few studies set out to explore the feasibility of NCT for patients experiencing VATS major lung resection (8,11,25).…”

“…Thoracic surgeons have tried amounts of methods to reduce postoperative pain and have achieved much progress such as reducing the number of chest tubes, using more flexible and slender chest tubes (21,26,27). Five of the nine included studies reported postoperative pain scale measured in the VAS (6,8,10,11,13) and three study reported the dosage of antalgesic (5,9,13). Patients in the NCT group have lighter pain in POD1 and used less antalgesic.…”

“…Recently, several centers have published their experience of NCT after VATS lung resection (7)(8)(9)(10)(11)(12)(13)(14). However, the efficacy and safety of NCT is still in debate.…”

Challenging dicta in thoracic surgery

“…Chest tubes, a ubiquitous presence on a thoracic surgery service, can be associated with significant neuralgia, tubing and connection-related issues, and iatrogenic pneumothorax at time of removal. A recent report by Lu and colleagues 9 documented a series of 44 patients in whom chest tubes were omitted after wedge resection. To select a low-risk group, only patients with peripheral lesions, healthy lung parenchyma, no intraoperative air leaks, hemorrhage or effusion accumulation, and no pleural adhesion were included.…”