Duration Of Chest Drainage Research Articles

Uniportal video-assisted thoracoscopic (VATS) subtotal parietal pleurectomy for refractory tuberculous pneumothorax: Five case-reports.

This study explored the safety and feasibility of uniportal video-assisted thoracoscopic (VATS) paretal pleurectomy in patients suffering from complex tuberculous pneumothorax. These cases were reported and summarized to present the experience of the authors with this procedure. The clinical data of a total of 5 patients with refractory tuberculous pneumothorax having undergone subtotal parietal pleurectomy by uniportal VATS in our institution were hereby collected from November 2021 to February 2022, and regular follow-up was conducted after surgery. Parietal pleurectomy via VATS was successfully performed in all these 5 patients, among which, 4 received bullectomy at the same time, with no conversion to open surgery. Among the 4 cases of full lung expansion who were suffering from recurrent tuberculous pneumothorax, the preoperative chest drain duration ranged from 6 days to 12 days; the operation time, from 120 minutes to 165 minutes; intraoperative blood loss, from 100 mL to 200 mL; the drainage volume, from 570 mL to 2000 mL 72 hours after operation; and chest tube duration, from 5 days to 10 days. One rifampicin-resistant case had satisfactory postoperative lung expansion, but left a cavity, the operation time of which was 225 minutes; intraoperative blood loss, 300 mL; the drainage volume, 1820 mL 72 hours after operation; and chest tube duration, 40 days. The follow-up time ranged from 6 months to 9 months, and no recurrence was noted. Parietal pleurectomy with preservation of the top pleura via VATS is a safe and satisfactorily effective procedure for patients with refractory tuberculous pneumothorax.

Biportal robotic surgery for anterior mediastinal mass.

Robotic-assisted surgery for mediastinal disease has been shown to be beneficial in facilitating easier mediastinal dissection with its three-dimensional views and multi-articulated moving instruments. Herein, we report our experience with the biportal approach of robot-assisted anterior mediastinal mass surgery, including both lateral transthoracic and subxiphoid approaches. We retrospectively analyzed 21 patients who underwent biportal robotic-assisted anterior mediastinal mass resection, without considering the tumor size between May 2018 and September 2022. We reviewed the technical advantages and limitations of the biportal approach and the perioperative outcomes, including operative time, conversion to multiport or open surgery, duration of chest drainage, and postoperative complications, to define the role of robot-assisted surgery using the biportal approach. We approached the thoracic cavity from the right side in five patients, from the left side in three patients, and from the subxiphoid in 13 patients. Thymomas (n=13) and thymic cysts (n=3) were the most common diagnoses. The median operative time was 165 min [interquartile range (IQR), 140-196 min]. There were no conversions to multiport or open surgery. The chest drain was removed at a median of two days (IQR, 1-3 days), and the patients were discharged at a median of four days (IQR, 3-5 days). Perioperative complications were reported in two patients (one with prolonged air leak and one with vocal cord palsy). There were no cases of readmission or delayed complication. The biportal approach for robot-assisted surgery in anterior mediastinal masses is a feasible and safe alternative for treating associated pathologies. The subxiphoid approach for mediastinal surgery provides a better surgical view than the transthoracic approach. The biportal approach also enables the use of robotic staplers and energy devices and minimizes instrumental interference compared to that in the single-port approach.

Clinical Comparative Analyses of Thymectomy Between Subxiphoid and Subcostal Arch Thoracoscopic Resection and Median Sternotomy for the Treatment of Thymoma With Myasthenia Gravis in Chinese Patients

IntroductionThis study aims to retrospectively compare the efficacy and safety of subxiphoid and subcostal arch thoracoscopic resection (SR) and the median sternotomy (MS) for thymoma with myasthenia gravis (MG) via propensity-matched analysis. MethodsWe retrospectively analyzed 502 patients with thymoma and MG in Tangdu Hospital of the Fourth Military Medical University from December 2012 to December 2017. The patients were allocated to SR group (n = 424) and MS group (n = 78). Perioperative outcomes were compared between SR group and MS group by using propensity-matched analysis. ResultsAll SR and MS operations were accomplished successfully. Most postoperative outcomes between the two groups showed no significant difference such as remission of MG and postoperative complication (P > 0.05). There were statistically significant differences between MS group and SR group in operation time [(116.3 ± 33.7) min versus (52.2 ± 31.3) min], intraoperative blood loss [(145.2 ± 26.7) mL versus (51.2 ± 10.3) mL], chest drainage duration (3.4 d versus 0 d), days of hospital-stay (5.2 d versus 2.7 d), patient satisfaction score (5.9 ± 2.3 versus 8.7 ± 1.2), the incidence of complications and pain scores, with all P values < 0.05. ConclusionsThis study suggests that subxiphoid and subcostal arch thoracoscopic resection is a less invasive procedure with good safety and feasibility as compared with median sternotomy for thymoma with myasthenia gravis.

Minimally Invasive Thymectomy Could Be Attempted for Locally Advanced Thymic Malignancies: A Real-World Study With Propensity Score-Matched Analysis

IntroductionIncreasing evidence supports minimally invasive thymectomy (MIT) for early stage thymic malignancies than open median sternotomy thymectomy (MST). Nevertheless, whether MIT could be attempted for locally advanced disease remains unclear. MethodsThe clinical data of consecutive patients with stage T2-3NxM0 (eighth edition TNM staging) thymic malignancies who underwent MIT or MST were identified from a prospectively maintained database. The co-resected structures were rated with a resection index to evaluate surgical difficulty. The impact of surgical approach on treatment outcomes was investigated through propensity score-matched analysis and multivariable analysis. ResultsFrom January 2008 to December 2019, a total of 128 patients were included; MIT was initially attempted in 58 (45.3%) cases, and eight (13.8%) were converted to MST during surgery. The conversion group had similar perioperative outcomes to the MST group, except for a longer operation time. After propensity score matching, the resection index scores were similar between the MIT and MST groups (3.5 versus 3.7, p = 0.773). The MIT group had considerably less blood loss (p < 0.001), fewer postoperative complications (p = 0.048), a shorter duration of chest drainage (p < 0.001), and a shorter hospitalization duration (p < 0.001) than the MST group. The 5-year freedom from recurrence rate was not different between the two groups (78.2% versus 78.5%, p = 0.942). In multivariable analysis, surgical approach was not associated with freedom from recurrence (p = 0.727). ConclusionsMIT could be safely attempted in carefully selected patients with locally advanced thymic tumors. Conversion did not compromise the surgical outcomes. Patients may benefit from the less traumatic procedure and thus better recovery, with comparable long-term oncologic outcomes.

Pulmonary sequestration in adult patients: a single-center retrospective study

BackgroundPulmonary sequestration (PS) is a rare congenital lower airway malformation. This study presents the clinical and imaging features and surgical outcomes of PS in adults, and compare the safety and feasibility of minimally invasive surgery versus open thoracotomy for PS.MethodsAdult patients with PS treated at our center from July 2011 to September 2021 were included. Information regarding the patient demographics, clinical and CT features, arterial supply and venous drainage, and surgical outcomes were collected.ResultsNinety seven patients were included. The most common CT findings were mass lesions (50.5%) and cystic lesions (20.6%). The vast majority of the lesions (96 out of 97) were located close to the spine in the lower lobes (left vs. right: 3.6 vs. 1). Arterial supply was mainly provided by the thoracic aorta (87.4%) and abdominal aorta (10.5%). Intralobar and extralobar PS accounted for 90.7% and 9.3% of the patients, respectively. Three (4.5%) patients who underwent minimally invasive surgery were converted to open thoracotomy due to dense adhesions. Though no significant differences regarding operative time (P = 0.133), the minimally invasive surgery group was significantly better than the open thoracotomy group regarding intraoperative blood loss (P = 0.001), drainage volume (P = 0.004), postoperative hospital days (P = 0.017) and duration of chest drainage (P = 0.001). There were no cases of perioperative mortality. Only four (4.1%) patients developed postoperative complications, and no significant difference existed between the two groups.ConclusionOur study revealed PS can present with a variety of different clinical and radiologic manifestations. Clinicians should consider the possibility of PS when diagnosing a lesion in the lower lobes close to the spine. Moreover, minimally invasive surgery is a safe and effective treatment modality for the treatment of PS in an experienced center.

Early Pleurodesis for Postoperative Air Leak with Autologous Blood and 50% Glucose Solution

Postoperative air leaks after pulmonary resection prolong the duration of chest drainage and the length of hospital stay. One of the many treatment options is bedside pleurodesis using various agents. This study evaluated the feasibility of an early intervention to stop postoperative air leaks with either autologous blood or a 50% glucose solution. We retrospectively reviewed 323 patients who underwent bedside pleurodesis between January 2017 and March 2022. Sixty-four patients received autologous blood patch pleurodesis, and 36 were treated with a 50% glucose solution after pulmonary resection. The primary endpoints were the total postoperative tube indwelling time, post-pleurodesis tube indwelling time, and hospital stay. A propensity score-matched analysis was performed. In the autologous blood patch pleurodesis and 50% glucose solution groups, the mean initiation timing of postoperative pleurodesis were 2.06±1.62 and 3.28±1.56 days, the mean duration of the tube indwelling time after surgery was 6.58±3.02 and 6.42±4.92 days, and the mean duration of the tube indwelling time after pleurodesis, it was 4.53±3.10 and 3.11±4.80 days, respectively. In addition, the total length of hospital stay was 9.11±5.42 and 7.83±4.75 days in the autologous blood patch pleurodesis and 50% glucose solution groups, respectively. Early postoperative air leak cessation with autologous blood patch pleurodesis or 50% glucose solution pleurodesis is a feasible procedure with acceptable outcomes that effectively shortens the hospital stay.

Comparison of clinical utility between digital and analog drainage systems in patients with spontaneous pneumothorax.

Digital drainage systems can continuously and numerically monitor air leakage, which may lead to a shorter duration of drainage and hospitalization; however, the usefulness of digital drainage systems compared to that of analog drainage systems for patients with primary or secondary spontaneous pneumothorax remains unclear. This retrospective study included 108 patients with spontaneous pneumothorax who were successfully treated with chest drainage alone at our institution. We compared the clinical efficacy of digital and analog chest drainage systems. From the study population, 68 patients were diagnosed with primary and the other 40 with secondary spontaneous pneumothorax. The analog drainage system was used in 44 patients, and the digital drainage system in 64 patients. Among patients with primary spontaneous pneumothorax, the digital group had a significantly shorter duration of chest drainage than the analog group (median 2 vs. 4 days; p=0.001), but there was no significant difference in those with secondary spontaneous pneumothorax. Additionally, the length and cost of hospitalization in the digital group were significantly lower than those in the analog group for both patients with primary and secondary spontaneous pneumothorax. There was no significant difference in recurrence within 1 week after chest tube removal between the two groups, neither among patients with primary nor among those with secondary pneumothorax. Digital drainage system may be better than analog drainage system for patients with primary spontaneous pneumothorax who need chest drainage, but further research is needed on drainage system selection for those with secondary disease.

Optimal Chest Drainage Method After Anatomic Lung Resection: A Prospective Observational Study

BackgroundSeveral methods for chest drainage after pulmonary resection of malignant lung tumors exist, but consensus on the ideal method has not been reached. MethodsWe conducted a multicenter prospective observational study. We enrolled 2200 patients who underwent lung resection for lung tumors. Of the 1470 patients who underwent anatomic resection, 347 showed air leak on the morning of postoperative day 1. They were assigned to 3 groups according to the chest drainage method on postoperative day 1. ResultsOf 347 patients with postoperative air leaks, 107 (30.8%), 179 (51.6%), and 61 (17.6%) were assigned to water seal, continuous suction, and digital drainage, respectively. The median postoperative air leak duration was significantly longer with digital drainage (4.0 days) than with either water seal (2.5 days) or continuous suction (3.0 days; P = .009). Chest tubes were required for significantly more days on average with digital drainage (6.0 days) than with water seal (4.0 days) or continuous suction (4.0 days; P = .003). Prolongation of air leak duration was significantly more likely to occur in patients with body mass index <18.5 kg/m2 (hazard ratio [HR], 1.6; 95% CI, 1.1-2.3), moderate or severe air leak on postoperative day 1 (HR, 2.0; 95% CI, 1.5-2.6), or digital drainage (HR, 1.4; 95% CI, 1.01-1.9). ConclusionsWater seal was associated with significantly shorter duration of postoperative air leak and chest drainage compared with continuous suction and digital drainage.

Safety and feasibility of a modularized procedure for trans-subxiphoid robotic extended thymectomy.

The purpose of this study was to introduce an "eight-step modularized procedure (M-RET)" for trans-subxiphoid robotic extended thymectomy for patients with myasthenia gravis (MG). Its safety and feasibility were further verified in this study. This retrospective study included 87 consecutive MG patients who underwent trans-subxiphoid robotic extended thymectomy at our institution between September 2016 and August 2021. According to different resection models, patients were divided into two groups: traditional trans-subxiphoid robotic extended thymectomy group (T-RET group)and eight-step modularized technique group (M-RET group). Baseline demographic characteristics and operation-related parameters were collected and compared between the two groups. There were 41 (47.1%) patients in the M-RET group and 46 (52.9%) patients in the T-RET group. The M-RET group resected a greater amount of mediastinal adipose tissues and required more dissection time (median and interquartile range: 135.0, 125.0 to 164.0 v. 120.0, 105.0 to 153.8, P = 0.006) compared with the T-RET group. There were no statistically significant differences in terms of the intraoperative blood loss, duration of chest drainage, length of hospital stay, and postoperative complications between the two groups. There was no mortality or conversion in each of the two groups and all patients recovered well upon discharge. The eight-step modularized technique of trans-subxiphoid robotic extended thymectomy was verified to be a safe, effective, radical procedure, which offers unique superiority over ectopic thymic tissue resection.

Complex vs. simple segmentectomy: comparing surgical outcomes in the left upper division.

Lung segmentectomy is an option for the treatment of noninvasive or minimally invasive lung cancer. For tumors located in the left upper division (LUD), LUD trisegmentectomy (S1+2 + S3) is frequently performed as a sublobar resection because of its technical simplicity. However, the differences in surgical outcomes between simple and complex segmentectomies remain unclear. We compared the surgical outcomes and frequency of postoperative complications of LUD trisegmentectomy (simple group) with those of complex segmentectomy (other than LUD trisegmentectomy; complex group) for pulmonary lesions using three-dimensional computed tomography between 2010 and 2021. In total, 118 patients were included: 65 in the simple group and 53 in the complex group (S1+2: 25, S3: 15, others: 13). There were no significant differences in surgical time or duration of postoperative chest drainage. However, the blood loss volume was significantly smaller in the complex group than in the simple group (12 vs. 36mL, p = 0.023), and major complications tended to occur less frequently in the complex group than in the simple group (3.8 vs. 13.8%, p = 0.061). Among patients who underwent intentional segmentectomy for primary lung cancer (n = 61), major complications were significantly less common in the complex group (p = 0.006). Complex segmentectomy can be performed safely under the guidance of three-dimensional CT. Complex segmentectomy itself is not a risk factor for postoperative complications when the intersegmental planes are sufficiently recognized and accurately cut.

Updated Evaluation of Robotic- and Video-Assisted Thoracoscopic Lobectomy or Segmentectomy for Lung Cancer: A Systematic Review and Meta-Analysis.

ObjectivesRobot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) are the two principal minimally invasive surgical approaches for patients with lung cancer. This study aimed at comparing the long-term and short-term outcomes of RATS and VATS for lung cancer.MethodsA comprehensive search for studies that compared RATS versus VATS for lung cancer published until November 31, 2021, was conducted. Data on perioperative outcomes and oncologic outcomes were subjected to meta-analysis. PubMed, Web of Science, and EMBASE were searched based on a defined search strategy to identify eligible studies before November 2021.ResultsTwenty-six studies comparing 45,733 patients (14,271 and 31,462 patients who underwent RATS and VATS, respectively) were included. The present meta-analysis showed that there were no significant differences in operative time, any complications, tumor size, chest drain duration, R0 resection rate, lymph station, 5-year overall survival, and recurrence rate. However, compared with the VATS group, the RATS group had less blood loss, a lower conversion rate to open, a shorter length of hospital stay, more lymph node dissection, and better 5-year disease-free survival.ConclusionsRATS is a safe and feasible alternative to VATS for patients with lung cancer.

Early post-operative benefits of a pulmonary valve-sparing strategy during Fallot repair

BackgroundPatients undergoing complete repair of tetralogy of Fallot generally have an excellent prognosis. Unfortunately, pulmonary valve reconstruction with a transannular patch is generally required. Resulting pulmonary regurgitation is associated with late right ventricular dysfunction and morbidity. Early pulmonary regurgitation may also be poorly tolerated. This study compares immediate outcomes of non-valved transannular patch repair (NV-TAP) to a valve-sparing (V-Sp) approach. Methods67 patients, with tetralogy of Fallot and severe pulmonary annular hypoplasia underwent complete repair between 2010 and 2018.23 patients had a NV-TAP repair while a V-Sp technique was used in 44 patients. Mortality, length of stay in the intensive care unit and hospital, use of inotropes, duration of mechanical ventilation, use and duration of dialysis, chest drainage duration, reinterventions, and postoperative complications were compared. Immediate outcomes were assessed by biological data and postoperative echocardiography. ResultsICU stay was shorter in the V-Sp group (5 days vs 8 days, p = 0.009). At postoperative day 1, Vasoactive Inotropic Score and mean dosage of adrenaline were significantly lower in the V-Sp group. Duration of inotrope use was significantly shorter. Hospital stay, mechanical ventilation, and chest drainage duration, the incidence and duration of dialysis all showed a trend towards being lower in the V-Sp group. Surgical complications were similar despite longer cardiopulmonary bypass and aortic cross-clamp durations. ConclusionRepair of the native pulmonary valve by a V-Sp technique reduces length of stay in the ICU and the use of inotropic agents in the immediate post-operative period.

Management of residual spaces after lung resections and air leaks: Ultrasound and pneumoperitoneum.

Prolonged chest tube drainage is one of the most common postoperative complications of pulmonary resections; it is related to complications such as residual pleural spaces or continuous alveolar air leaks. We retrospectively evaluated the efficacy of artificial intraoperative pneumoperitoneum in the treatment of such complications after lung resections. The presence of a residual space associated with prolonged air leaks can be difficult to treat, exposes the patient to a high risk of infection, prolongs hospitalization, and in some cases mandates reoperation. Between October 2016 and March 2020, four patients underwent pneumoperitoneum. The obliteration of the pleural cavity and the absence of air leaks were observed in 3 patients; only 1 patient was discharged with a Heimlich valve. Artificial intraoperative pneumoperitoneum is a safe and simple procedure. It decreases the duration of chest drainage and of the hospital stay; however, further studies are needed to corroborate our data. The learning curve for this technique may be relatively short.

Factors Associated with Duration of Intercostal Chest Drainage in Patients with Primary Spontaneous Pneumothorax and the Role of Pulmonary Rehabilitation.

PurposePrimary spontaneous pneumothorax (PSP) is an urgent/emergency condition. Treatment with intercostal chest drainage (ICD) is necessary, particularly in symptomatic patients or those with tension. A previous study found that systematic breathing exercise significantly reduced ICD duration when compared with controls. This study aimed to evaluate if pulmonary rehabilitation can reduce the duration of ICD treatment in patients with PSP.Patients and MethodsThis was a retrospective study of patients diagnosed with PSP treated with ICD. Duration of ICD treatment was recorded from patients’ medical charts. Factors associated with ICD duration were calculated using linear regression analysis.ResultsThere were 66 patients who met the study criteria, with average (SD) age and body mass index of 31.68 (13.53) years and 20.94 (2.72) kg/m2. The majority of the patients were male (72.73%), and average (SD) duration of ICD treatment was 9.90 (7.83) days. Three factors remained in the final model: body mass index, systolic blood pressure, and recurrent PSP. Two factors were independently associated with longer ICD duration: systolic blood pressure and recurrent PSP, with adjusted coefficients of 0.21 (p value 0.041) and 7.69 (p value 0.039), respectively. Pulmonary rehabilitation was not included in the final model.ConclusionPatients with a history of recurrent PSP or high systolic blood pressure at presentation may require longer ICD duration. Pulmonary rehabilitation was not associated with the duration of ICD treatment.

A simple size-tailored algorithm for the removal of chest drain following minimally invasive lobectomy: a prospective randomized study

BackgroundThe pleural space can resorb 0.11–0.36 ml/kg of body weight/hour (h) per hemithorax. There are only a limited number of studies on thresholds for chest drain removal (CDR) and all are based on arbitrary amounts, for example, 300 ml/day. We studied an individualized size-based threshold for CDR–specifically 5 ml/kg, a simple, easily applicable measure.MethodsThis is a single-center prospective randomized trial enrolling 80 patients undergoing VATS lobectomy. There were two groups: an experimental (E) group, in which once the daily output went down to 5 ml/kg the chest drain was removed and a control (C) group, with chest drain removal as per our current practice of less than 250 ml/day.ResultsThe groups did not differ in pre- and peri- and postoperative characteristics, except for chest drain duration (mean, SD 2.02 ± 0.97 vs. 3.25 ± 1.39 days, p < 0.001) and length of hospital stay (median, IQR 4.5; 3 vs. 6; 2.75 days, p = 0.008) in favor of E group. The re-intervention rate was the same in both groups (once in each group).ConclusionThe new threshold for chest drain removal following thoracoscopic lobectomy of 5 ml/kg/d leads to both shorter chest drainage and hospital stay without apparent increase in morbidity. (Clinical registration number: DRKS00014252).

Clinical efficacy of digital chest drainage system in cardiac valve surgery.

The portable digitalized suction was used widely in thoracic surgery. The aim of the study was to access the early outcomes of using the portable digitalized suction system after cardiac surgery. We invested 80 patients including 30 women (mean age 72.7 ± 9.2years) who underwent cardiac surgery at our hospital, excluded coronary artery bypass grafting only, with or only aortic surgery, emergency operation, and patients with hemodialysis. Patients were categorized as those treated with digital chest drainage system (DCS group, n = 38) or analog chest drainage system (ACS group, n = 42), and the following data were analyzed in two groups. The primary endpoint was the duration of chest drainage, and the secondary endpoints were the rate of drainage-related complications and the length of hospitalization. The duration of drainage was significantly shorter in the DCS group (ACS vs. DCS = 94.8 ± 31.5 vs. 81.1 ± 20.6h, p = 0.036). The duration needed for rehabilitation completion was significantly shorter in the DCS group (ACS vs. DCS = 10.7 ± 1.2 vs. 9.6 ± 1.5days, p = 0.047), and the length of hospitalization was significantly shorter in the DCS group (ACS vs. DCS = 21.9 ± 5.3 vs. 18.8 ± 7.2days, p = 0.031). This study provided evidence that DCS might be effective for patients who underwent cardiac valve surgery.

Routine Chest Roentgenogram After Chest Tube Removal Is Not Indicated for Minimally Invasive Lung Resection

BackgroundChest roentgenograms after chest tube removal are common practice in postoperative thoracic surgery patients. Whether these roentgenograms change clinical management is debatable. We investigated prevalence and management of post-pull pneumothoraces after lung resection. MethodsPatients undergoing minimally invasive wedge resections, segmentectomies, and lobectomies between March 2018 and September 2018 were retrospectively reviewed. Baseline factors, operative technique, chest tube management, and outcomes after post-pull chest roentgenograms, and factors associated with post-pull pneumothoraces were analyzed. ResultsThe study analyzed 200 consecutive patients comprising 117 wedge resections (59%), 24 segmentectomies (12%), and 59 lobectomies (30%). Wedge resections compared with segmentectomy or lobectomy had lower rates of chest tube use, drain duration, air leaks, and need for a clamp trial, with Blake drains most often removed last compared with segmentectomy or lobectomy (all P < .001). Post-pull pneumothoraces, which were largely small/tiny/trace (96%), occurred in 110 patients (55%). Five patients experienced symptoms, and no patients required intervention. Resection type was associated with the pneumothorax rate, need for additional imaging, and discharge timing (all P < .05). Those with pneumothoraces compared with those without differed in type of resection and chest drain, presence of air leak within 24 hours of removal, need for clamp trial, order of tube removal, and hospital length of stay (all P < .05). Multivariable regression showed only clamp trial was associated with post-pull pneumothorax development (odds ratio, 2.48; 95% CI, 1.13-5.45; P = .024). ConclusionsAlthough routine use of post-pull chest roentgenograms identified a high prevalence of pneumothorax, no intervention was required. Our study demonstrates post-pull imaging may not be indicated in asymptomatic patients without prior air leak or clamp trial.

Comparison of single-port, multi-port video-assisted thoracoscopic and open lobectomy for children: a single-center experience.

The feasibility of single-port video-assisted thoracic surgery (SPVATS) for pediatric lobectomy has not been clearly established. We compared the feasibilities of single-port (SP), multi-port (MP) VATS and open lobectomy (OL) for surgical treatment of children with lung disease. In this study, we retrospectively analyzed and compared data for 22,19 and 30 pediatric lung disease patients who had been subjected to SP, MP and OL, respectively. These procedures were performed between March, 2012 and August, 2020 at the Second Affiliated Hospital of Wenzhou Medical University. Perioperative clinical indicators were analyzed. Compared to OL, SP was associated with lower intraoperative blood loss (p = 0.008), lower postoperative thoracic drainage volume (p = 0.041),shorter chest drainage duration (p = 0.002) and hospital stay (p = 0.001). Operation time (p = 0.437), volume of estimated blood loss (p = 0.979), conversion rate to thoracotomy (p = 0.861), total thoracic drainage volume (p = 0.824), duration of chest tube drainage (p = 0.543), length of hospital stay (p = 0.812) and incidences of postoperative complications were comparable in MP and SP groups. SPVATS is a safe and feasible approach for lobectomy in pediatrics, with comparable postoperative clinical outcomes to MPVATS and better outcomes relative to OL. However, studies with large sample sizes in multicenter should be performed to verify our findings.

Does interatrial communication affect post-operative course of children undergoing tetralogy of Fallot repair? Single centre retrospective cohort study: propensity score matching.

During tetralogy of Fallot repair, leaving or even create an interatrial communication may facilitate post-operative course particularly with right ventricle restrictive physiology. The aim of our study is to assess the influence of atrial communication on post-operative course of tetralogy of Fallot repair. Retrospectively, we studied all children who had tetralogy of Fallot repair (2003-2018). We divided them into two groups: tetralogy of Fallot repair with interatrial communication (TOFASD) group and tetralogy of Fallot repair with intact atrial septum (TOFIAS) group. We performed propensity match score for specific pre- or intra-operative variables and compared groups for post-operative outcome variables. Secondarily, we looked for right ventricle restrictive physiology incidence and influence of early repair performed before 3 months of age on post-operative course. One hundred and sixty children underwent tetralogy of Fallot repair including (93) cases of TOFIAS (58%) and (67) cases of TOFASD (42%). With propensity matching score, 52 patients from each group were compared. Post-operative course was indifferent in term of positive pressure ventilation time, vasoactive inotropic score, creatinine and lactic acid levels, duration and amount of chest drainage and length of intensive care unit and hospital stay. Right ventricle restrictive physiology occurred in 38% of patients with no effects on outcome. 12/104 patients (12%) with early repair needed longer pressure ventilation time (p = 0.003) and intensive care unit stay (p = 0.02). Leaving interatrial communication in tetralogy of Fallot repair did not affect post-operative course. As well, right ventricle restrictive physiology did not affect post-operative course. Infants undergoing early tetralogy of Fallot repair may require longer duration of positive pressure ventilation time and intensive care unit stay.

A service evaluation exploring time on physiotherapy caseload following lung lobectomy surgery

Background The number of lobectomy procedures performed in the United Kingdom (UK) continues to increase annually increasing pressure on thoracic surgical bed capacity. Physiotherapy following thoracic surgery can encourage earlier patient independence helping to reduce hospital length of stay and decrease pressure on hospital beds. The purpose of the service evaluation was to explore whether age, gender, type of surgical incision, day first mobilised and chest drain duration affected time on physiotherapy caseload following lobectomy surgery at one teaching hospital. The findings could support the identification of individuals at risk of longer times on physiotherapy caseloads and help direct physiotherapy rehabilitation provision towards these individuals. Methods A retrospective service evaluation was conducted in a UK teaching hospital. Data were retrospectively collected from 1st July 2015–30th June 2016 for all patients reviewed by the cardiothoracic physiotherapy team following lobectomy surgery. Data were collected from patients’ physiotherapy ward sheets, chest radiograph and an electronic patient database and included: date of surgery; day discharged from physiotherapy; age; gender; type of surgical incision; day first mobilised; day chest drains removed. Results 135 individuals were treated by the physiotherapy team following lobectomy surgery within the data collection period. Time on physiotherapy caseload was longer for females and for those who had longer chest drain durations. Time on physiotherapy caseload was reduced by having a VATS incision and was not affected by the patient’s age. Day mobilised postoperatively was an independent predictor of time on physiotherapy caseload however after adjusting for other covariates it was not statistically significantly associated with time on physiotherapy caseload. Conclusion Reviewing chest drain removal practices and providing more intensive physiotherapy input following thoracotomy are worth greater exploration to ascertain whether these interventions could further reduce time on physiotherapy caseload following lobectomy surgery.