Abstract
Purpose
The aim of the present study was to assess the feasibility and safety of several improved criteria to avoid chest tube placement after thoracoscopic wedge resection of the lung.
Methods
From 2000 to 2009, 333 patients who underwent thoracoscopic wedge resections of the lung were reviewed. The patients were classified into two groups: (1) the no chest tube group (NCT), consisting of 132 patients in whom chest tubes were not placed because no air leakage or bleeding during intraoperative alternative sealing test was confirmed, and (2) the chest tube placement (CTP) group, consisting of 201 patients in whom chest tubes were placed because the criteria for the nonplacement of a chest tube were not met. The clinical data and postoperative morbidity were assessed between the two groups.
Results
The number of specimens (1.3 vs 1.5) and the endostapler cartridges used (2.5 vs 3.3), and the duration of the postoperative hospital stay (4.6 vs 6.7 days) in the NCT group were significantly lower than in the CTP group. One patient from the NCT group required chest tube insertion due to the development of late pneumothorax. However, no significant differences were found between the two groups.
Conclusions
Our improved criteria are therefore considered to positively contribute to a safe and definite clinical decision regarding postoperative patient management.
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References
Watanabe A, Watanabe T, Ohsawa H, Mawatari T, Ichimiya Y, Takahashi N, et al. Avoiding chest tube placement after video-assisted thoracoscopic wedge resection of the lung. Eur J Cardiothorac Surg 2004;25:872–876.
Luckraz H, Rammohan KS, Phillips M, Abel R, Karthikeyan S, Kulatilake NEP, et al. Is an intercostal chest drain necessary after video-assisted thoracoscopic (VATS) lung biopsy? Ann Thorac Surg 2007;84:237–239.
Blewett CJ, Bennett WF, Miller JD, Urschel JD. Open lung biopsy as an outpatient procedure. Ann Thorac Surg 2001;71:1113–1115.
Satherley LK, Luckraz H, Rammohan KS, Phillips M, Kulatilake NEP, O’Keefe PA. Routine placement of an intercostal chest drain during video-assisted thoracoscopic surgical lung biopsy unnecessarily prolongs in-hospital length of stay in selected patients. Eur J Cardiothorac Surg 2009;36:737–740.
Chang AC, Yee J, Orringer MB, Iannettoni MD. Diagnostic thoracoscopic lung biopsy: an outpatient experience. Ann Thorac Surg 2002;74:1942–1946.
Russo L, Wiechmann RJ, Magovern JA, Szydlowski GW, Mark MJ, Naunheim KS, et al. Early chest tube removal after video-assisted thoracoscopic wedge resection of the lung. Ann Thorac Surg 1998;66:1751–1754.
Fibla JJ, Molins L, Simon C, Pérez J, Vidal G. Early removal of chest drainage after videothoracoscopic lung biopsy. Interact Cardiovasc Thorac Surg 2006;5:581–583.
Varela G, Jiménez MF, Novoa NM, Aranda JL. Postoperative chest tube management: measuring air leak using an electronic device decreases variability in the clinical practice. Eur J Cardiothorac Surg 2009;35:28–31.
Cerfolio RJ, Bryant AS. Results of a prospective algorithm to remove chest tubes after pulmonary resection with high output. J Thorac Cardiovasc Surg 2008;135:269–273.
Marshall MB, Deeb ME, Bleier JI, Kucharczuk JC, Friedberg JS, Kaiser LR, et al. Suction vs water seal after pulmonary resection: a randomized prospective study. Chest 2002;121:831–835.
Antanavicius G, Lamb J, Papasavas P, Caushaj P. Initial chest tube management after pulmonary resection. Am Surg 2005;71:416–419.
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Nakashima, S., Watanabe, A., Mishina, T. et al. Feasibility and safety of postoperative management without chest tube placement after thoracoscopic wedge resection of the lung. Surg Today 41, 774–779 (2011). https://doi.org/10.1007/s00595-010-4346-5
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DOI: https://doi.org/10.1007/s00595-010-4346-5