Off-Label Use of T-Tube as Chest Drainage for Uniportal Surgery

Ambrogi, Vincenzo; Rocca, Eleonora La; Carlea, Federica; Tacconi, Federico

doi:10.1016/j.athoracsur.2021.01.075

Cited by 6 publications

(5 citation statements)

References 7 publications

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“…The main concern is that, due to the higher location of the single incision in uniportal VATS (IV-V intercostal space), the chest tube inserted through this space may not provide adequate fluid, air drainage and lung expansion, particularly after upper lobectomies [13]. Several authors provided possible solutions, evaluating the efficacy of the use of a modified T-tube [15] or an additional pleural catheter compared to a standard chest tube after uniportal VATS lobectomy [12,13].…”

Section: Discussionmentioning

confidence: 99%

“…Some studies [12,13,15] proposed possible solutions, such as the use of two chest tubes through the uniportal VATS incision [12], or the use of an additional pleural catheter (16 GA CVC) inserted in the VII/VIII intercostal spaces alone [12], or associated with the insertion of a single chest tube through the uniportal VATS incision [13].…”

Section: Introductionmentioning

confidence: 99%

“…Another solution is the employment of a modified T-tube, usually used in biliary duct surgery, for the simultaneous drainage of air and fluid [15].…”

Section: Introductionmentioning

confidence: 99%

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Are the Efficacy and Safety of Chest Tubes in Uniportal Video-Assisted Thoracic Surgery Related to the Level of Intercostal Space Insertion or to the Drain Type? A Prospective Multicenter Study

Nachira,

Bertoglio,

Ismail

et al. 2024

JCM

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Objectives: The aim of this study is to evaluate if the efficacy and safety of chest tube placement are influenced by the level of intercostal space insertion (uniportal VATS vs. biportal VATS) or by the type of drain employed (standard vs. smart coaxial drain). Methods: Data on patients who underwent either uniportal or biportal VATS upper lobectomies with lymphadenectomy were prospectively collected in three European centers. The uniportal VATS group with a 28 Fr standard chest tube (U-VATS standard) was compared with the uniportal VATS group with a 28 Fr smart drain (U-VATS smart), and U-VATS smart was also compared with biportal VATS with a 28 Fr smart drain inserted in the VIII intercostal space (Bi-VATS smart). Results: When comparing the U-VATS standard group with the U-VATS smart, a higher fluid output was recorded in the U-VATS smart (p: 0.004) in the III post-operative day (p.o.) and overall (p: 0.027), with a lower 90-day re-admission in the U-VATS smart (p: 0.04). The Bi-VATS smart group compared to U-VATS smart showed a higher fluid output in the I p.o. (p < 0.001), with no difference in total fluid amount or hospitalization. The Bi-VATS smart recorded a lower incidence (p < 0.001) of residual pleural space or effusion (p: 0.004) at chest X-rays prior to drain removal but a higher level of pain and chronic intercostal neuralgia (p: 0.03). Conclusions: Chest tube insertion through the same incision space in uniportal VATS seems to be safe and effective. Smart drains can improve the fluid output in uniportal VATS, as if the drainage were inserted in a lower space (i.e., biportal VATS), but with less discomfort.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Are the Efficacy and Safety of Chest Tubes in Uniportal Video-Assisted Thoracic Surgery Related to the Level of Intercostal Space Insertion or to the Drain Type? A Prospective Multicenter Study

Nachira,

Bertoglio,

Ismail

et al. 2024

JCM

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“…The liquid accumulating at the base of the pleural cavity may hinder lung complete re-expansion, favoring post-operative infections. Therefore, a T-shaped tube with two extremities directed toward both the apex and the basis of the pleural cavity has been recently implemented at our institution ( 28 ).…”

Section: Surgical Techniquesmentioning

confidence: 99%

Non-intubated Thoracic Surgery: Wedge Resections for Peripheral Pulmonary Nodules

2022

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The feasibility of performing pulmonary resections of peripheral lung nodules has been one of the main objectives of non-intubated thoracic surgery. The aim was to obtain histological characterization and extend a radical intended treatment to oncological patients unfit for general anesthesia or anatomic pulmonary resections. There is mounting evidence for the role of wedge resection in early-stage lung cancer treatment, especially for frail patients unfit for general anesthesia and anatomic resections with nodules, demonstrating a non-aggressive biological behavior. General anesthesia with single lung ventilation has been associated with a higher risk of ventilator-induced barotrauma and volotrauma as well as atelectasis in both the dependent and non-dependent lungs. Nonetheless, general anesthesia has been shown to impair the host immune system, eventually favoring both tumoral relapses and post-operative complications. Thus, non-intubated wedge resection seems to definitely balance tolerability with oncological radicality in highly selected patients. Nonetheless, differently from other non-surgical techniques, non-intubated wedge resection allows for histological characterization and possible oncological targeted treatment. For these reasons, non-intubated wedge resection is a fundamental skill in the core training of a thoracic surgeon. Main indications, surgical tips, and post-operative management strategies are hereafter presented. Non-intubated wedge resection is one of the new frontiers in minimal invasive management of patients with lung cancer and may become a standard in the armamentarium of a thoracic surgeon. Appropriate patient selection and VATS expertise are crucial to obtaining good results.

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“…To overcome this issue, our group started to employ off-label a T-shaped tube (Figure 1 ), usually applied in biliary duct surgery [ 2 ] and developed on purpose by Redax SpA (Poggio Rusco, Italy), as a pleural drainage [ 3 ] (Figure 2 ) after having obtained the authorization from the Internal Review Board of our institution.…”

Section: Introductionmentioning

confidence: 99%

The effectiveness of chest T-tube drainage in uniportal video-assisted thoracic surgery

Patirelis

Carlea

Torto

et al. 2023

Interdisciplinary CardioVascular and Thoracic Surgery

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OBJECTIVES Uniportal incision located at 4th or 5th intercostal space represents a problem for the correct drainage of distal areas of pleural cavity. The T-shaped tube can drain both the extremities of pleural space. In this study we evaluated the effectiveness of T-chest tube compared to classic chest tube after uniportal video-assisted thoracic surgery. METHODS We compared the effectiveness of T tube and classic 28 CH chest drainage after different surgical procedures in uniportal VATS: lobectomies, wedge resections, pleural and mediastinal biopsies. As primary end-points, drained effusion and evidence of pneumothorax at post-operative day 1, subcutaneous emphysema, tube kinking, obstruction and necessity of repositioning or post-operative thoracentesis were considered. Pain at 6 and 24 hours after surgery, pain at tube removal and mean hospitalization were analyzed as secondary end-points. RESULTS A total of 109 patients was selected for the study, 51 included to the T-tube group while the other 58 ones to the control group with classic drainage. Patients with T-tube showed a significantly lower rate of pneumothorax (29.4% vs 63.8%; p < 0.001), tube kinking (5.9% vs 27.6%; p = 0.003) and need of repositioning (2.0% vs 12.1%; p = 0.043). No significant results were obtained in subcutaneous emphysema (p = 0.26), tube obstruction (p = 0.32), drained effusion (p = 0.11) and need of post-operative thoracentesis (p = 0.18). Patients with T-tube complained of less pain 6 hours after surgery (p < 0.001). Conversely, T-tube removal was reported to be more painful (p < 0.001). CONCLUSIONS Chest T-tube can achieve significantly lower rate of postoperative pneumothorax, kinking and repositioning with less pain 6 hours after surgery compared to classic tube.

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Off-Label Use of T-Tube as Chest Drainage for Uniportal Surgery

Cited by 6 publications

References 7 publications

Are the Efficacy and Safety of Chest Tubes in Uniportal Video-Assisted Thoracic Surgery Related to the Level of Intercostal Space Insertion or to the Drain Type? A Prospective Multicenter Study

Are the Efficacy and Safety of Chest Tubes in Uniportal Video-Assisted Thoracic Surgery Related to the Level of Intercostal Space Insertion or to the Drain Type? A Prospective Multicenter Study

Non-intubated Thoracic Surgery: Wedge Resections for Peripheral Pulmonary Nodules

The effectiveness of chest T-tube drainage in uniportal video-assisted thoracic surgery

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