Intra-operative removal of chest tube in video-assisted thoracoscopic procedures

Objective

Thoracic Surgery has witnessed a massive revolution in the last 25 years with the standardization of video-assisted thoracoscopic surgery as the best approach of the thoracic operations. Earlier, when thoracic surgery was done through the huge thoracotomy incisions and rib spreading retractors with their excruciating pain, the chest tube pain was masked, but using VATS, has caused surgeons seeking early removal of chest tubes. With advances of the instruments and stapling devices, the amount of air-leak was significantly reduced, diminishing the time needed for chest tube drainage.

Methods

A prospective study, from May 2014 to December 2016, included 29 patients admitted to the service in Faculty of Medicine, Assiut University. Patients had different clinical presentations. Undergoing VATS procedures (uni-portal VATS in all except one), they were then divided into two groups: study group, those with intra-operative removal of chest tube, (16 patients) and control group (13 patients). Patients would undergo an air-leak test.

Results

The two groups had a significant difference in the post-operative mean pain score (study group 4.9 & control group 7.8), and hospital stay (study group 1.4 & control group 4). Both groups were similar in occurrence of post-operative pneumothorax (study group 25% & control group 23.1%), with only 2 patients (12.5%) in the study group requiring re-insertion of chest tube.

Conclusions

Intra-operative removal of chest tube during VATS procedures was a safe technique in well selected patients with an intra-operative successful air-leak test with radiological and clinical follow-up. This technique provided lesser post-operative pain with shorter hospital stay.