Is chest tube drainage necessary after subxiphoid thoracoscopic thymectomy?

Abstract

Background: Subxiphoid thoracoscopic thymectomy has been increasingly performed in recent years. This study aimed to assess the differences in outcomes between subxiphoid thoracoscopic thymectomy with and without chest tube drainage. Methods: Overall, 205 subxiphoid thoracoscopic thymectomy operations were performed for myasthenia gravis, including 90 cases without and 115 cases with chest tube drainage. The clinical characteristics and perioperative outcomes of the patients were compared. Results: The patients included 112 women and 93 men, with a mean age of 41 years. Two patients in the group without and 5 patient in the group with chest tube drainage developed dyspnea. In the group without chest tube, 6 patients had residual pneumothorax or pleural effusion and had a thoracentesis after surgery (6/90). In the group with chest tube, 7 patients developed delayed pleural effusion and had a thoracentesis after chest tube removal (7/ 115). The patients in the group without chest tube drainage group yielded lower pain scores. Conclusions: The omission of chest tube drainage may be a feasible and safe choice for patients with myasthenia gravis undergoing subxiphoid thoracoscopic thymectomy, but further prospective studies are required.

A chest tube after robotic thymectomy is unnecessary

“… 9 Xu and colleagues 10 reported a retrospective case series of 20 patients who underwent thoracoscopic thymectomy without chest tube placement, in which no patients experienced postoperative complications and no patients required a postoperative drainage procedure. Li and colleagues 11 reported a comparative retrospective study of 205 patients who underwent subxiphoid thoracoscopic thymectomy, in which chest tubes were placed in 115 patients and omitted in 90 patients. Significantly lower pain scores were observed in the patients who did not receive a chest tube.…”

Short-term analysis of uniport video-assisted thoracoscopic surgery via the subxiphoid approach without chest tube drainage for anterior mediastinal tumors: a comparative retrospective study

“…We also used CT scan reconstructions to estimate the amount of pleural effusion, which indicated no statistical difference among the three groups. Li et al also found no difference between patients with or without chest tubes regarding the incidence of dyspnea and delayed pleural effusion requiring thoracentesis after chest tube removal (20). Recent studies have witnessed the progress of VATS surgical technique via subxiphoid approach, including the non-intubation, "fourzone one-way" method, which further decreased the trauma and enhanced the postoperative recovery (21,22).…”

Efficacy and safety of omitting chest drains after video-assisted thoracoscopic surgery: a systematic review and meta-analysis

“…One systematic review (18) published in 2010 including one randomized controlled trial (RCT) (19) and three observational studies (20)(21)(22), and another with meta-analysis (23) of nine observational studies (20,(24)(25)(26)(27)(28)(29)(30)(31) was published in 2018. Subsequently, additional three RCTs (32)(33)(34) and six observational studies (35)(36)(37)(38)(39)(40) were published.…”