TY - JOUR
T1 - Thoracoscopic pulmonary wedge resection without post-operative chest drain
T2 - an observational study
AU - Holbek, Bo Laksafoss
AU - Hansen, Henrik Jessen
AU - Kehlet, Henrik
AU - Petersen, René Horsleben
PY - 2016/10/1
Y1 - 2016/10/1
N2 - OBJECTIVE: Chest drains are used routinely after wedge resection by video-assisted thoracoscopic surgery (VATS), although this practice is based largely on tradition rather than evidence. Chest drains may furthermore cause pain, infections, and prolonged length of stay. The aim of this prospective observational study was to assess the feasibility of avoiding chest drains following VATS wedge resection for pulmonary nodules.METHODS: Between 1 February and 25 August 2015 166 consecutive patients planned for VATS wedge resection of pulmonary nodules were screened for inclusion using the following criteria: Forced expiratory volume in 1 s (FEV1) ≥60 % of expected, FEV1/forced vital capacity ≥70 %, tumour diameter ≤2 cm, distance from tumour to visceral pleura ≤3 cm, ≤2 separate wedges, no air leak on an intraoperative air leakage test and absence of severe adhesions, bullous/emphysematous disease, pleural effusion and coagulopathy. Chest X-rays were done twice on the day of surgery. 30-day complications were compiled from patient records.RESULTS: 49 patients underwent 51 unilateral VATS wedge resections without using a post-operative chest drain. No patient required reinsertion of a chest drain. 30 (59 %) patients had a pneumothorax of mean size 12 ± 12 mm on supine 8-h post-operative X-ray for which the majority resolved spontaneously within 2-week control. There were no complications on 30-day follow-up. Median length of stay was 1 day.CONCLUSIONS: The results support that VATS wedge resection for pulmonary nodules without a post-operative chest drain may be safe in a selected group of patients.
AB - OBJECTIVE: Chest drains are used routinely after wedge resection by video-assisted thoracoscopic surgery (VATS), although this practice is based largely on tradition rather than evidence. Chest drains may furthermore cause pain, infections, and prolonged length of stay. The aim of this prospective observational study was to assess the feasibility of avoiding chest drains following VATS wedge resection for pulmonary nodules.METHODS: Between 1 February and 25 August 2015 166 consecutive patients planned for VATS wedge resection of pulmonary nodules were screened for inclusion using the following criteria: Forced expiratory volume in 1 s (FEV1) ≥60 % of expected, FEV1/forced vital capacity ≥70 %, tumour diameter ≤2 cm, distance from tumour to visceral pleura ≤3 cm, ≤2 separate wedges, no air leak on an intraoperative air leakage test and absence of severe adhesions, bullous/emphysematous disease, pleural effusion and coagulopathy. Chest X-rays were done twice on the day of surgery. 30-day complications were compiled from patient records.RESULTS: 49 patients underwent 51 unilateral VATS wedge resections without using a post-operative chest drain. No patient required reinsertion of a chest drain. 30 (59 %) patients had a pneumothorax of mean size 12 ± 12 mm on supine 8-h post-operative X-ray for which the majority resolved spontaneously within 2-week control. There were no complications on 30-day follow-up. Median length of stay was 1 day.CONCLUSIONS: The results support that VATS wedge resection for pulmonary nodules without a post-operative chest drain may be safe in a selected group of patients.
KW - Adult
KW - Aged
KW - Chest Tubes
KW - Feasibility Studies
KW - Female
KW - Forced Expiratory Volume
KW - Humans
KW - Lung Neoplasms
KW - Male
KW - Middle Aged
KW - Multiple Pulmonary Nodules
KW - Patient Selection
KW - Pneumonectomy
KW - Pneumothorax
KW - Postoperative Care
KW - Prospective Studies
KW - Radiography, Thoracic
KW - Thoracic Surgery, Video-Assisted
KW - Vital Capacity
KW - Journal Article
KW - Observational Study
U2 - 10.1007/s11748-016-0692-6
DO - 10.1007/s11748-016-0692-6
M3 - Journal article
C2 - 27510705
SN - 1863-6705
VL - 64
SP - 612
EP - 617
JO - General Thoracic and Cardiovascular Surgery
JF - General Thoracic and Cardiovascular Surgery
IS - 10
ER -