title: Thoracoscopic pulmonary wedge resection without post-operative chest drain: an observational study.
abstract: OBJECTIVE
  Chest drains are used routinely after wedge resection by video-assisted thoracoscopic surgery (VATS), although this practice is based largely on tradition rather than evidence. Chest drains may furthermore cause pain, infections, and prolonged length of stay. The aim of this prospective observational study was to assess the feasibility of avoiding chest drains following VATS wedge resection for pulmonary nodules.
  
  
  METHODS
  Between 1 February and 25 August 2015 166 consecutive patients planned for VATS wedge resection of pulmonary nodules were screened for inclusion using the following criteria: Forced expiratory volume in 1 s (FEV1) ≥60 % of expected, FEV1/forced vital capacity ≥70 %, tumour diameter ≤2 cm, distance from tumour to visceral pleura ≤3 cm, ≤2 separate wedges, no air leak on an intraoperative air leakage test and absence of severe adhesions, bullous/emphysematous disease, pleural effusion and coagulopathy. Chest X-rays were done twice on the day of surgery. 30-day complications were compiled from patient records.
  
  
  RESULTS
  49 patients underwent 51 unilateral VATS wedge resections without using a post-operative chest drain. No patient required reinsertion of a chest drain. 30 (59 %) patients had a pneumothorax of mean size 12 ± 12 mm on supine 8-h post-operative X-ray for which the majority resolved spontaneously within 2-week control. There were no complications on 30-day follow-up. Median length of stay was 1 day.
  
  
  CONCLUSIONS
  The results support that VATS wedge resection for pulmonary nodules without a post-operative chest drain may be safe in a selected group of patients.
authors: Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. bo.laksafoss.holbek@regionh.dk.|Section for Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark. bo.laksafoss.holbek@regionh.dk.
authors: Bo Laksáfoss
authors: BL
authors: Holbek
authors: Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
authors: Henrik Jessen
authors: HJ
authors: Hansen
authors: Section for Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
authors: Henrik
authors: H
authors: Kehlet
authors: Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
authors: René Horsleben
authors: RH
authors: Petersen
mesh_terms: D000328:Adult; D000368:Aged; D015505:Chest Tubes; D005240:Feasibility Studies; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D018579:Patient Selection; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000209:etiology; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D013902:Radiography, Thoracic; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*; D014797:Vital Capacity / Q000502:physiology
keywords: Chest tubes; Lung neoplasms/surgery; Morbidity; Postoperative care/methods; Thoracic surgery; Video-assisted