Avoiding chest tube placement after video-assisted thoracoscopic wedge resection of the lung.

Abstract

A chest tube is usually placed in the pleural cavity after wedge resection of the lung, even after thoracoscopic procedures. The aim of this study was to determine the validity and safety of postoperative management without chest tube placement for patients undergoing thoracoscopic wedge resection of the lung. Between 1998 and 2002, 93 patients underwent thoracoscopic wedge resection of the lung. In January 2000, we established the following criteria for avoiding chest tube placement: (1) absence of air leaks during intraoperative alternative sealing test, (2) absence of bullous or emphysematous changes on inspection, (3) absence of severe pleural adhesions, and (4) absence of prolonged pleural effusion requiring chest drainage preoperatively. Seventeen of 93 patients did not satisfy the criteria. The other 76 patients were divided into two groups: group 1 consisted of 34 patients who underwent thoracoscopic resection before 1999 and in whom a chest tube was routinely placed in spite of retrospectively meeting the criteria, group 2 consisted of 42 patients who underwent thoracoscopic resection after 2000 and in whom chest tube was not placed. The clinical data were evaluated and analyzed between the two groups. Two patients in group 1 required new intervention after removal of a chest tube that had been inserted during the operation due to recurrence of a pneumothorax, so did two patients in group 2 after the operation. The rate of late pneumothorax requiring intervention is similar in groups 1 and 2. No differences were found between the two groups with regard to postoperative chest pain and hospital stay. No patients experienced a significant adverse outcome. Avoiding the chest tube placement did not increase postoperative morbidity if carefully selected criteria are met.