Position of a Chest Tube at Video-Assisted Thoracoscopic Surgery for Spontaneous Pneumothorax

Abstract

Background:Video-assisted thoracoscopic surgery (VATS) is a good therapeutic option for young patients with primary spontaneous pneumothorax (PSP), but there sometimes exists unexpected prolonged hospital stay due to air leak after the operation. Objectives: The goal of this retrospective study was to clarify if the position of the chest tube placed at VATS for PSP affected the periods of postoperative hospital stay. Methods: Seventy-one cases with PSP under age 40 who undertook VATS from January 1994 to February 2001 were examined for several factors. They were classified into two groups by the location of the tip of the chest tube placed at VATS as follows: upper medial pleural space (group I) and outside of there (group II). Results:Fifty-three of the 71 cases (75%) were classified in group I and 18 (25%) were in group II. Between the two groups, there were no differences as to preoperative characteristics of the patients and intraoperative findings of blebs or bullae. On the other hand, postoperative air leak-related complications were more frequent in group II than in group I (p = 0.004). Mean postoperative hospital stay was 5.1 ± 1.9 days in group I and 8.4 ± 4.3 days in group II (p < 0.0001). Conclusions:Patients with the tip of the chest tube in the upper medial pleural space at VATS could be discharged earlier than the other patients. The chest tube placement is one of the important factors for the outcome of VATS for PSP.

A modified two-port thoracoscopic technique versus axillary minithoracotomy for the treatment of recurrent spontaneous pneumothorax: a prospective randomized study

“…After removal of the chest tube, pain usually subsides, and the patient can leave the hospital the day of chest tube removal or the day after if the lungs are fully expanded on chest radiography. Similar results concerning chest tube drainage and hospital stays are reported in other published series [7,14,22].…”

Targeted wire-guided chest tube placement: a cadaver study

“…One can argue that it is very important to place the tube in the intended position inside pleural cavity. Our concept, regarding the usefulness of the precise chest tube positioning is in accordance with Chen et al [2]. They concluded that the precise chest tube positioning in the upper medial pleural space during video-assisted thoracoscopic surgery for spontaneous pneumothorax has shortened the period of patients' hospitalization.…”

“…Some recent studies point towards certain advantages in the use of wire-guided chest drainage [1]. Recently, Chen et al [2] stressed the importance of precise chest tube positioning in the pleural cavity during the video-assisted thoracoscopy in patients with pneumothorax. The aim of this study is to compare the precision of two different techniques of the chest tube insertion, a classical surgical (CS) tube thoracostomy and a targeted wire-guided (TWG) technique.…”

Diffuse Cystic Disease of the Lung Associated with Simultaneous Bilateral Spontaneous Pneumothorax: An Unknown Component of Caroli Disease?

“…Surgery (open thoracotomy or video-assisted thoracic surgery) is not without its hazards, especially for patients with severe underlying lung disease, poor pulmonary reserve and concomitant medical problems [3, 6, 7]. A similar condition was present in our patient; we did not prefer to perform any more invasive surgical procedure such as videothoracoscopy or open surgery because of the diffuse and excessive multi-bullous nature of parenchyma associated with the increased operative risk due to CD.…”