Thoracoscopy in Children: Is a Chest Tube Necessary?

Abstract

Purpose: Historically, a chest tube or drain has been left following a thoracic operation to allow drainage of air or fluid in the postoperative period. However, in patients undergoing thoracoscopy, the tube is often the greatest source of postoperative pain. We began excluding chest tubes several years ago and therefore are reviewing our experience to evaluate the safety and efficacy of this approach. Methods: A retrospective review of the medical record was performed on patients undergoing thoracoscopy at two centers from 1993 to 2007. Patients who left the operating room without a chest tube were included in this series. Patient demographics, type of operation, and outcome were recorded.

Thoracic neuroblastoma: a retrospective review of our institutional experience with comparison of the thoracoscopic and open approaches to resection

“…In some cases, a chest tube was not placed at all after either thoracoscopy or thoracotomy. This technique has been demonstrated to be safe in selected cases [13]. Smaller wounds, minimal rib trauma, and shorter chest tube duration may contribute to the faster postoperative recovery and shorter length of stay after thoracoscopic resection compared to thoracotomy patients.…”

An Official American Thoracic Society Clinical Practice Guideline: Classification, Evaluation, and Management of Childhood Interstitial Lung Disease in Infancy

“…The evidence described here derives from four single-center observational studies (16,135,142,143) that compared the safety, diagnostic yield, operative time, and postoperative course of lung biopsy via VATS with lung biopsy via open thoracotomy in patients with chILD syndrome. Our confidence in the findings is limited by the study design, risk for bias (i.e., nonconsecutive patient selection and single-center enrollment), and small sample size with few events.…”

Video-assisted thoracic surgery resection for pediatric mediastinal neurogenic tumors

“…The lack of thoracic drainage did not represent risk in the selected cases [5,13] and, in fact, may have prevented pain and decreased the risk of contamination.…”

“…Cases with abdominal neurogenic tumor or intraabdominal extension and those in whom surgical removal of tumor was not possible (submitted only to biopsy) were not included. The 3 institutions use similar criteria for chest tube use and removal and for hospital discharge in these cases [12,13].…”