The Validation of a No-Drain Policy After Thoracoscopic Major Lung Resection

Murakami, Junichi; Ueda, Kazuhiro; Tanaka, Toshiki; Kobayashi, Tsuyoshi; Kunihiro, Yoshie; Hamano, Kimikazu

doi:10.1016/j.athoracsur.2017.03.030

Cited by 42 publications

(28 citation statements)

References 17 publications

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“…Interestingly, wedge resection in certain reports was considered to be a risk factor for postoperative air leak. One study limits the number of wedge resections to ≤2, and Ueda et al even excluded wedge resections for omitting chest tube after VATS (14,20,21). In our cohort, we chose the patients with peripheral lesions ≤2 cm, with no obstructive ventilatory defect (FEV1 ≥1.5 L), and with no pleural adhesions for sublobar resections.…”

Section: Discussionmentioning

confidence: 99%

“…We excluded patients with wedge resections in ≥3 separate locations and limited the resection size to <2 anatomic segments as a larger residual pleural space would be expected if a larger portion of lung was resected. However, a study of major pulmonary resection under intubated general anesthesia omitting the chest tube has been reported (21). With more experience, tubeless singleport VATS for major pulmonary resection (lobectomy) in selected patients may be feasible.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Tubeless single-port thoracoscopic sublobar resection: indication and safety

Liu¹,

Hsu²,

Chien³

et al. 2018

J. Thorac. Dis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Tubeless single-port thoracoscopic sublobar resection: indication and safety

Liu¹,

Hsu²,

Chien³

et al. 2018

J. Thorac. Dis.

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“…[13–17] Meanwhile, Ueda et al and Murakami et al had reported that they successfully avoided leaving chest tubes during major lung resection through the refined strategy for pneumostasis. [18,19] With regard to children undergoing thoracoscopic operation, Todd had demonstrated that leaving no chest tubes (NCTs) after some no- lung manipulation (ductus arteriosus ligation, congenital diaphragmatic repair, among others) or tiny tissue dissection (lung biopsy) was feasible and allowed for a much more tolerable postoperative course in most children. [6] However, considering the difficulty of dealing with children undergoing thoracoscopic anatomical lobectomy, to date, chest tube placement is a regular procedure, and the chest tube placement time should be at least 1.3 days.…”

Section: Introductionmentioning

confidence: 99%

A chest tube may not necessary in children thoracoscopic lobectomy

Cheng

Miao²,

Xu³

et al. 2019

Medicine

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Drainage of the thorax postoperatively using chest tubes is a standard procedure in thoracic surgery. However, chest tubes can induce pain and immobilization, increase risk of infection, deteriorate the ventilation capacity, and increase difficulty of postoperative management, particularly in children. This study aimed to investigate the safety and effect of excluding chest tubes after performing thoracoscopic lobectomy in selected children. A retrospective review of medical records was performed in West China Hospital of Sichuan University from January 2014 to June 2018. Patients who underwent thoracoscopic lobectomy without chest tubes were recorded. Patients with accompanying severe pulmonary infection, extensive thoracic adhesions, or undeveloped interlobar fissure were excluded. In total, 246 patients underwent thoracoscopic lobectomy without a chest tube, and none required chest drain insertion or reintervention during hospitalization and follow-up at 90 days postoperatively. Among them, 2 (0.81%) patients developed a delayed pneumothorax which was found after being discharged, and resolved spontaneously in 2 weeks. No hemothorax, atelectasis, and bronchial fistula were found. Furthermore, 202 (82.1%) patients developed subcutaneous emphysema, which was asymptomatic and spontaneously resolved within 3 to 7 days. The length of postoperative hospital stay was 2 days; patients were discharged in the 3rd day postoperatively. Patients could recover to free mobilization and resume regular diet at 6 hours postoperatively. All patients were followed up for at least 3 months; no other complications were found, and all patients recovered well. This study showed that chest tube placement in selected patients may be unnecessary in children undergoing thoracoscopic lobectomy. The minimally invasive procedure and meticulous resection have been the preconditions of this procedure, which may contribute to a rapid recovery and can avoid the chest tube-related complications effectively.

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“…has compared the efficacy of small versus large chest tubes for use in thoracic trauma but no statistically significant difference was found . Recently, Ueda and colleagues reported the validity of their original strategy for omitting chest tube drainage after major lung resection . However, there is no generally accepted approach to chest tube management and clinical experience is still the most important basis in chest tube strategy …”

Section: Introductionmentioning

confidence: 99%

Comparison of the results of two chest tube managements during an enhanced recovery program after video‐assisted thoracoscopic lobectomy: A randomized trial

Cui

Zhang

et al. 2019

Thoracic Cancer

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Background This study compared the results of the application of two different chest tube management systems; a drainage ball with low negative pressure and the more commonly used chest tube with water‐sealed bottle, after video‐assisted thoracoscopic (VATS) lobectomy. Methods A total of 60 patients undergoing lobectomy were enrolled into this prospective open label randomized clinical trial and equally divided into two groups. The data collected in the trial included age, gender, forced expiratory volume in 1 second (FEV1), blood loss, operation time, drainage volume, drainage time, length of stay, postoperative pain score according to the Visual Analogue Scale (VAS) within 24 hours after surgery and chest tube removal. This study was registered at http://clinicaltrials.gov (NCT03598296). Results The characteristics of the patients were similar in both groups. Group ball patients had a lower pain score (after operation: 3.47 ± 1.80 vs. 6.20 ± 1.56, P < 0.001; after removal of chest tube: 1.47 ± 1.28 vs. 3.00 ± 1.29, P < 0.001); less analgesic used (2.83 ± 2.09 times vs. 5.00 ± 3.24 times, P = 0.003); less drainage time (upper tube: 3.89 ± 1.63 days vs. 5.10 ± 2.02 days, P = 0.048; lower tube: upper lobe 4.84 ± 1.61 days vs. 5.90 ± 1.52 days, P = 0.041; lower lobe: 3.82 ± 1.08 days vs. 5.70 ± 2.63 days, P = 0.042) and shorter length of stay (5.40 ± 1.65 days vs. 6.37 ± 1.99 days, P = 0.045). All other related parameters were similar in both groups. Conclusions For patients undergoing lobectomy, using a drainage ball with negative pressure could reduce hospitalization days and postoperative pain compared with the more commonly used chest tube with water‐sealed bottle when a strict postoperative curative procedure was performed.

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The Validation of a No-Drain Policy After Thoracoscopic Major Lung Resection

Abstract: The outcome of our validation cohort revealed that a no-drain policy is safe in selected patients undergoing thoracoscopic major lung resection and that it may contribute to an early recovery.

Cited by 42 publications

References 17 publications

Tubeless single-port thoracoscopic sublobar resection: indication and safety

Tubeless single-port thoracoscopic sublobar resection: indication and safety

A chest tube may not necessary in children thoracoscopic lobectomy

Comparison of the results of two chest tube managements during an enhanced recovery program after video‐assisted thoracoscopic lobectomy: A randomized trial

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