Safety of one 8.5-Fr pigtail catheter for postoperative continuous open gravity drainage after uniportal video-assisted thoracoscopic surgery pneumonectomy

Abstract

OBJECTIVES Uniportal video-assisted thoracoscopic surgery pneumonectomy (U-VATS-P) is feasible and safe from a perioperative standpoint in clinical practice. How to choose proper chest tube and drainage method is an important step in enhanced recovery after surgery (ERAS) protocols. In this study, we aimed to assess the safety of one 8.5-Fr (1Fr = 0.333mm) pigtail catheter for postoperative continuous open gravity drainage after U-VATS-P. METHODS We retrospectively reviewed a single surgeon’s experience of U-VATS-P for lung cancer from May 2016 to September 2022. Patients were managed with one 8.5-Fr pigtail catheter for postoperative continuous open gravity drainage after U-VATS-P. The clinical characteristics and perioperative outcomes of the patients were retrospectively analyzed. RESULTS In total, 77 patients underwent the placement of one 8.5-Fr pigtail catheter for postoperative continuous open gravity drainage after U-VATS-P for lung cancer. The mean age was 60.9\(\pm\)7.39 (40–76) years old; the median operative time was 191.38\(\pm\)59.32min; the mean operative hemorrhage was 109.46\(\pm\)96.56ml; the mean duration of postoperative chest tube drainage was 6.80\(\pm\)2.33 days; the mean drainage volume in the first three days after operation was 186.31\(\pm\)50.97, 321.97\(\pm\)52.03, 216.44\(\pm\)35.67ml respectively; the mean postoperative hospital stay was 7.90\(\pm\)2.58 days. No patient experienced complications resulting from chest tube malfunction. Ten patients experienced minor complications. One patient with non-life-threatening empyema and bronchopleural fistula required short rehospitalization for anti-inflammatory therapy and re-intubation. Three patients with chylothorax were treated with intravenous nutrition. Four patients had atrial fibrillation that were controlled by antiarrhythmic therapy. Two patients had more thoracic hemorrhagic exudation after operation that could be found in time and were cured effectively and discharged from the hospital uneventfully after early hemostatic therapy and nutritional support. CONCLUSIONS Insertion of one 8.5-Fr pigtail catheter for postoperative continuous open gravity drainage after U-VATS-P is a safe and effective procedure in the treatment of lung cancer without a major increase in morbidity or mortality and should be popularized.

Outcomes of Video-Assisted Thoracoscopic Wedge Resection Using a Non-Crushing Clamp and Continuous Sutures Plus Hemovac Drains Versus Staplers Plus Conventional Chest Tube: A Comparative Study

“…In contrast, drainage systems speci cally designed for thoracic surgery, such as chest tubes, can cause more pain, longer drainage periods, and greater amounts of drainage uid [10,12,16]. Hemovac drains are primarily designed for use in general surgery, orthopedic surgery, and plastic surgery to remove uids (such as blood or serous uid) from the surgical site [17].…”

“…Despite having a smaller diameter tube and a lower ow rate, hemovac drains did not signi cantly affect the total volume of uid or air to be drained over a relatively extended period. In a recent prospective randomized study comparing pigtail catheters and chest tubes, the application of a drain with a smaller diameter, such as a pigtail, instead of a chest tube, did not pose problems in terms of drainage e cacy or perioperative safety [10]. In a prospective, single-center, randomized study, comparing the use of a 2-lumen central venous catheter (7 Fr × 20 cm) with a 20-24 Fr chest tube in patients undergoing wedge resection, no signi cant differences were observed between the two groups in terms of postoperative pneumothorax, pleural effusion, or the need for chest tube reinsertion [18].…”

“…It has been suggested that the use of smaller chest tubes may result in less postoperative pain compared to larger tubes [20]. A recent study comparing the use of a pigtail catheter with a chest tube in patients undergoing VATS showed that the drainage strategy was the sole factor in uencing the frequency of intervention-requiring pain [10]. A prospective study examining VATS lobectomies using a Foley catheter or a 28F chest tube demonstrated that the Foley catheter caused signi cantly less pain than the chest tube [21].…”

“…Chest tubes, which can cause signi cant pain and discomfort and might be one of the main obstacles to enhanced recovery after surgery (ERAS), have been considered a proper drainage strategy after lung surgery for decades in universal clinical practice. However, they actually might be one of the main obstacles to ERAS [10]. In recent years, studies have been published in which drain types such as pigtail and pleural catheters were used instead of chest tubes [11].…”