Thoracoscopic pulmonary wedge resection without post-operative chest drain: an observational study

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 -