Is an Intercostal Chest Drain Necessary After Video-Assisted Thoracoscopic (VATS) Lung Biopsy?

Luckraz, Heyman; Rammohan, Kandadai; Phillips, Mabel; Abel, Rob; Karthikeyan, Siva; Kulatilake, Nihal; O’Keefe, Peter

doi:10.1016/j.athoracsur.2007.03.007

Cited by 60 publications

(75 citation statements)

References 5 publications

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“…In our study, the incidence rate of postoperative pneumothorax was 9.8% in the OT group and 19.4% in the PC group, which are consistent with previous reports 18, 19, 20. However, on the other hand, patients in the tubeless strategy groups (OT + PC groups) had reduced postoperative pain based on NRS scores compared to the RT group (RT vs. OT vs. PC: 3.4 ± 1.1 vs. 2.3 ± 0.9 vs. 2.3 ± 0.8, respectively; P < 0.001).…”

Section: Discussionsupporting

confidence: 93%

“…Recently, there has been considerable interest in the literature on the omission of chest tube drainage for certain patients, suggesting that the omission of chest tube drainage for thoracoscopic wedge resected patients could be an alternative, less invasive option 15. However, the complete removal of drainage might increase the rate of complications, especially pneumothorax, and some patients may need chest tube reinsertion 14, 15, 19. In our study we used a prophylactic air‐extraction strategy for thoracoscopic wedge resected patients.…”

Section: Discussionmentioning

confidence: 99%

“…The tubeless strategy, which directly omits chest tube drainage, was first used in a thoracoscopic wedge resected population 13, 14, 15, 16, 17. However, previous studies have reported that this procedure has an increased rate of complications, especially pneumothorax (5.9–40%) 15, 18, 19, 20. Thus, some investigators have suggested the use of a preset air‐extraction catheter for prophylactic or remedial air‐extraction, which we call a prophylactic air‐extraction strategy.…”

Section: Introductionmentioning

confidence: 99%

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Prophylactic air‐extraction strategy after thoracoscopic wedge resection

et al. 2018

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BackgroundSince the conception of enhanced recovery after surgery protocols, tubeless strategies have become popular. Herein, we introduce a previously unreported alternative air‐extraction strategy for patients who have undergone thoracoscopic wedge resection and explore its feasibility and safety.MethodsBetween January 2015 and June 2017, 264 consecutive patients underwent thoracoscopic wedge resection with different drainage strategies. Patients were divided according to the postoperative drainage strategies used: routine chest tube drainage (RT group), complete omission of chest tube drainage (OT group), and prophylactic air‐extraction catheter insertion procedure (PC group). Using the propensity score matching method, clinical parameters and objective operative qualities were compared among the three groups.ResultsOptimal 1:1 matching was used to form pairs of RT (n =36) and PC (n =36) groups and balance baseline characteristics among the three groups. The incidence rates of pneumothorax were 5.6% (2/36), 9.8% (5/51), and 19.4% (7/36) in the RT, OT, and PC groups, respectively (P = 0.07). Chest tube reinsertion incidence for postoperative pneumothorax was 19.4% (1/7) in the PC group and 60% (3/5) in the OT group. Other postoperative complications were comparable among these groups.ConclusionsThe prophylactic air‐extraction strategy may be an alternative procedure for selected patients. Remedial air extraction may reduce the occurrence of chest tube reinsertion for pneumothorax patients, but further investigation is required.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prophylactic air‐extraction strategy after thoracoscopic wedge resection

et al. 2018

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“…In the near future, there will be a progressive reduction in the incisions used to access the pleural space in diagnostic procedures and an even greater reduction in hospital stays, since biopsies will be performed on an outpatient basis, as well as a lower rate of chest tube use, contributing to the reduction in morbidity and mortality. (30) In some situations, biopsies of the middle lobe and lingular segment have advantages over biopsies of other sites due to their anatomical characteristics. The volume and depth of a lung biopsy is known to affect the diagnostic yield and the quality of the biopsy in interstitial lung diseases.…”

Section: Resultsmentioning

confidence: 99%

Análise semiquantitativa de biópsias cirúrgicas de diferentes lobos pulmonares de pacientes com pneumonia intersticial usual/fibrose pulmonar idiopática

Gonçalves¹,

Leão

Ferreira

et al. 2009

J. bras. pneumol.

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Objective: To evaluate the differences between surgical biopsies of distinct lung lobes in terms of the histopathological features of usual interstitial pneumonia, using a semiquantitative score. Methods: We selected all of the patients diagnosed with idiopathic pulmonary fibrosis and submitted to surgical biopsy in two distinct lobes between 1995 and 2005 at the Hospital São Paulo and other hospitals operated by the Federal University of São Paulo. In the histological evaluation of the specimens, we used a semiquantitative method based on previous studies, assigning a score to each of the biopsied sites. Results: In this sample of patients, we found no statistically significant differences that would alter the stage of the disease, based on the score used. This finding was independent of the biopsy site (middle lobe or lingular segment). Conclusions: No significant histological differences were found between the lung lobes studied. The definitive histological diagnosis of usual interstitial pneumonia did not alter the stage of the disease.Keywords: Lung diseases, interstitial; Pulmonary fibrosis; Thoracic surgery; Pathology; Thoracic surgery, video-assisted. ResumoObjetivo: Avaliar as diferenças histológicas da pneumonia intersticial usual entre biópsias cirúrgicas de lobos pulmonares distintos, utilizando um escore semiquantitativo. Métodos: Foram selecionados todos os pacientes com o diagnóstico de fibrose pulmonar idiopática e submetidos à biópsia cirúrgica em dois lobos distintos no Hospital São Paulo e em hospitais afiliados da Universidade Federal de São Paulo, no período entre 1995 e 2005. Foi utilizado um método semiquantitativo na avaliação histológica dos espécimes, com base em estudos prévios, aplicando-se um escore para cada local submetido à biópsia. Resultados: Nenhuma diferença estatisticamente significante foi encontrada nesta amostra de pacientes que viesse alterar o estágio da doença, com base no escore utilizado. Este achado foi independente do local da biópsia (lobo médio ou segmento lingular). Conclusões: Não foram observadas diferenças histológicas significantes entre os lobos pulmonares estudados. O diagnóstico histológico definitivo de pneumonia intersticial usual não alterou o estágio da doença.

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“…(23) Some authors have questioned the need for thoracic drainage after biopsy through video-assisted thoracoscopy in certain patients. (24,25) They state that, in the absence of air leak after the procedure, thoracic drainage is optional, and that foregoing thoracic drainage can shorten hospital stays and avoid procedure-related morbidity.…”

Section: Discussionmentioning

confidence: 99%

A videotoracoscopia no diagnóstico das doenças difusas do parênquima pulmonar

et al. 2009

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Objective: To evaluate the role of video-assisted thoracoscopy in the diagnosis of diffuse parenchymal lung diseases. Methods: The medical charts of patients suspected of having diffuse parenchymal lung disease were retrospectively reviewed, as were the results of the anatomopathological examination of lung biopsy specimens collected through video-assisted thoracoscopy. Results: Of the 48 patients included in the study, 25 (52.08%) were female and 23 (47.92%) were male. The mean age was 58.77 years (range, 20-76 years). A total of 54 biopsy fragments were submitted to anatomopathological examination: 24 (44.44%) from the lingula; 10 (18.52%) from the left lower lobe; 7 (12.96%) from the right middle lobe; 6 (11.11%) from the right lower lobe; 5 (9.26%) from the left upper lobe; and 2 (3.71%) from the right upper lobe. The mean duration of thoracic drainage was 2.2 days. Adverse events included conversion to thoracotomy, in 2 patients (4.17%), and residual pneumothorax, in 1 (2.08%). The definitive diagnosis was made in 46 patients (95.83%), and idiopathic interstitial pneumonia was the predominant diagnosis (in 54.18%). The most common diagnoses were usual interstitial pneumonia (in 29.27%), nonspecific interstitial pneumonia (in 16.67%) and hypersensitivity pneumonia (in 12.50%). Conclusions: Lung biopsy through video-assisted thoracoscopy is a safe, effective and viable procedure for the diagnosis of diffuse parenchymal lung diseases.Keywords: Lung diseases, interstitial; Thoracoscopy; Diagnosis. ResumoObjetivo: Analisar o papel da videotoracoscopia no diagnóstico das doenças difusas do parênquima pulmonar. Métodos: Os prontuários de pacientes com suspeita de doenças difusas do parênquima pulmonar e os resultados do exame anatomopatológico das amostras de biópsia pulmonar por videotoracoscopia foram analisados retrospectivamente. Resultados: Dos 48 pacientes incluídos no estudo, 25 (52,08%) eram do sexo feminino, e 23 (47,92%) eram do sexo masculino. A idade média foi de 58,77 anos, variando entre 20 e 76 anos. Foi realizado o exame anatomopatológico de 54 fragmentos de biópsia pulmonar: 24 (44,44%) da língula; 10 (18,52%) do lobo inferior esquerdo; 7 (12,96%) do lobo médio; 6 (11,11%) do lobo inferior direito; 5 (9,26%) do lobo superior esquerdo; e 2 (3,71%) do lobo superior direito. O tempo médio de drenagem torácica foi de 2,2 dias. Como eventos adversos, houve conversão para toracotomia em 2 pacientes (4,17%) e pneumotórax residual em 1 (2,08%). O diagnóstico definitivo foi obtido em 46 (95,83%) casos, com predomínio das pneumonias intersticiais idiopáticas (54,18%). Os diagnósticos mais frequentes foram pneumonia intersticial usual (29,27%), pneumonia intersticial não-específica (16,67%) e pneumonia por hipersensibilidade (12,50%). Conclusões: A videotoracoscopia com biópsia pulmonar é um procedimento eficaz, seguro e viável para o diagnóstico das doenças difusas do parênquima pulmonar.

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Is an Intercostal Chest Drain Necessary After Video-Assisted Thoracoscopic (VATS) Lung Biopsy?

Cited by 60 publications

References 5 publications

Prophylactic air‐extraction strategy after thoracoscopic wedge resection

Prophylactic air‐extraction strategy after thoracoscopic wedge resection

Análise semiquantitativa de biópsias cirúrgicas de diferentes lobos pulmonares de pacientes com pneumonia intersticial usual/fibrose pulmonar idiopática

A videotoracoscopia no diagnóstico das doenças difusas do parênquima pulmonar

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