Application of uniportal video-assisted thoracoscopic surgery without chest tube in enhanced recovery after thoracic surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Man ,  GUO Zhanlin , LIANG Junguo , JIN Zhiyong , KANG Shirong

Department of Thoracic Surgery, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, P.R.China;

Corresponding author：

GUO Zhanlin, Email: nmggzl@163.com

Keywords：

Uniportal; video-assisted thoracoscopic surgery; chest drainage

DOI：

10.7507/1007-4848.2018110042

Video：

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Objective To investigate the clinical feasibility and safety of uniportal video-assisted thoracoscopic surgery (VATS) without chest tube in enhanced recovery thoracic surgery.Method The clinical data of patients with pulmonary bulla, pulmonary nodules and mediastinal tumors who underwent uniportal VATS in Department of Thoracic Surgery in the Affiliated Hospital of Inner Mongolia Medical University between January 2015 to May 2018 were retrospectively analyzed. A total of 78 patients did not receive closed thoracic drainage tube (a tube-free group), including 30 males and 48 females aged 32.5±8.3 years, 92 patients closed thoracic drainage tube after operation (a control group), including 38 males and 54 females aged 31.4±13.6 years. The surgery-related indicators, postoperative complications and visual analogue score (VAS) were compared between the two groups.Results The time of early ambulation and hospital stay after operation in the tube-free group (1.0±0.3 d, 3.3±0.7 d) were significantly shorter than those in the control group (1.8±0.6 d, 5.2±0.8 d) (P=0.000, P=0.000). The VAS pain scores on the first, second and third day after operation in the tube-free group (4.5±1.8, 3.6±2.4, 2.5±1.4) were also significantly lower than those in the control group (6.8±2.2, 5.7±2.9, 3.9±1.2) (P=0.000, P=0.000, P=0.000). Operation time and intraoperative blood loss in the tube-free group (55.3±12.2 min, 21.5±5.1 mL) and the control group (57.1±6.5 min, 22.2±3.5 mL) were not statistically different (P=0.220, P=0.146). There was no pulmonary infection in both groups, and the wound healing rate was 100.0%. There was no significant difference in pneumothorax, pleural effusion, arrhythmia and re-insertion of chest drain between the tube-free group (5 patients, 8 patients, 1 patient, 3 patients) and the control group (1 patient, 4 patients, 2 patients, 1 patient, P=0.145, P=0.134, P=0.885, P=0.499).Conclusion In strictly screened patients undergoing uniportal thoracoscopic surgery, no thoracic closed drainage tube can relieve postoperative pain, promote early ambulation activities and enhanced recovery of patients.

Citation： ZHANG Man, GUO Zhanlin, LIANG Junguo, JIN Zhiyong, KANG Shirong. Application of uniportal video-assisted thoracoscopic surgery without chest tube in enhanced recovery after thoracic surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(12): 1219-1222. doi: 10.7507/1007-4848.2018110042 Copy

1.	Reinersman JM, Passera E, Rocco G. Overview of uniportal video-assisted thoracic surgery (VATS): past and present. Ann Cardiothorac Surg, 2016, 5(2): 112-117.
2.	Swierzy M, Faber S, Nachira D, et al. Uniportal video-assisted thoracoscopic surgery for the treatment of thoracic emergencies. J Thorac Dis, 2018, 10(Suppl 31): S3720-S3725.
3.	ADL S. Uniportal lung cancer surgery: The state of the evidence. Ann Thorac Surg, 2018, 10(6): 205-208.
4.	Bjerregaard LS, Jensen K, Petersen RH, et al. Early chest tube removal after video-assisted thoracic surgery lobectomy with serous fluid production up to 500 ml/day. Eur J Cardiothorac Surg, 2014, 45(2): 241-246.
5.	Park JB, Hwang JJ, Lee WS, et al. Postoperative chest tube placement after thoracoscopic wedge resection of lung for primary spontaneous pneumothorax: is it mandatory. J Thorac Dis, 2018, 10(8): 4812-4818.
6.	Deng B, Qian K, Zhou JH, et al. Optimization of chest tube management to expedite rehabilitation of lung cancer patients after video-assisted thoracic surgery: a meta-analysis and systematic review. World J Surg, 2017, 41(8): 2039-2045.
7.	张满, 靳智勇, 马英, 等. 自主呼吸麻醉结合单孔非置管胸腔镜技术在肺大疱切除术中应用的随机对照试验. 中国胸心血管外科临床杂志, 2018, 25(3): 218-221.
8.	Yang X, Li M, Yang X, et al. Uniport versus multiport video-assisted thoracoscopic surgery in the perioperative treatment of patients with T1-3N0M0 non-small cell lung cancer: a systematic review and meta-analysis. J Thorac Dis, 2018, 10(4): 2186-2195.
9.	Yang HC, Cho S, Jheon S. Single-incision thoracoscopic surgery for primary spontaneous pneumothorax using the SILS port compared with conventional three-port surgery. Surg Endosc, 2013, 27(1): 139-145.
10.	Kutluk AC, Kocaturk CI, Akin H, et al. Which is the best minimal invasive approach for the treatment of spontaneous pneumothorax? Uniport, two, or three ports: A prospective randomized trail. Thorac Cardiovasc Surg, 2018, 66(7): 589-594.
11.	Li L, Tian H, Yue W, et al. Subxiphoid vs intercostal single-incision video-assisted thoracoscopic surgery for spontaneous pneumothorax: A randomised controlled trial. Int J Surg, 2016, 30: 99-103.
12.	Akter F, Routledge T, Toufektzian L, et al. In minor and major thoracic procedures is uniport superior to multiport video-assisted thoracoscopic surgery. Interact Cardiovasc Thorac Surg, 2015, 20(4): 550-555.
13.	Gao S, Zhang Z, Aragón J, et al. The Society for Translational Medicine: clinical practice guidelines for the postoperative management of chest tube for patients undergoing lobectomy. J Thorac Dis, 2017, 9(9): 3255-3264.
14.	Takamochi K, Imashimizu K, Fukui M, et al. Utility of objective chest tube management after pulmonary resection using a digital drainage system. Ann Thorac Surg, 2017, 104(1): 275-283.
15.	卢礼卿, 程远大, 张春芳. 单孔胸腔镜手术无胸腔引流管留置在胸外科快速康复中的应用. 中华胸部外科电子杂志, 2017, 4(3): 159-163.
16.	Lu TY, Chen JX, Chen PR, et al. Evaluation of the necessity for chest drain placement following thoracoscopic wedge resection. Surg Today, 2017, 47(5): 606-610.

1. Reinersman JM, Passera E, Rocco G. Overview of uniportal video-assisted thoracic surgery (VATS): past and present. Ann Cardiothorac Surg, 2016, 5(2): 112-117.
2. Swierzy M, Faber S, Nachira D, et al. Uniportal video-assisted thoracoscopic surgery for the treatment of thoracic emergencies. J Thorac Dis, 2018, 10(Suppl 31): S3720-S3725.
3. ADL S. Uniportal lung cancer surgery: The state of the evidence. Ann Thorac Surg, 2018, 10(6): 205-208.
4. Bjerregaard LS, Jensen K, Petersen RH, et al. Early chest tube removal after video-assisted thoracic surgery lobectomy with serous fluid production up to 500 ml/day. Eur J Cardiothorac Surg, 2014, 45(2): 241-246.
5. Park JB, Hwang JJ, Lee WS, et al. Postoperative chest tube placement after thoracoscopic wedge resection of lung for primary spontaneous pneumothorax: is it mandatory. J Thorac Dis, 2018, 10(8): 4812-4818.
6. Deng B, Qian K, Zhou JH, et al. Optimization of chest tube management to expedite rehabilitation of lung cancer patients after video-assisted thoracic surgery: a meta-analysis and systematic review. World J Surg, 2017, 41(8): 2039-2045.
7. 张满, 靳智勇, 马英, 等. 自主呼吸麻醉结合单孔非置管胸腔镜技术在肺大疱切除术中应用的随机对照试验. 中国胸心血管外科临床杂志, 2018, 25(3): 218-221.
8. Yang X, Li M, Yang X, et al. Uniport versus multiport video-assisted thoracoscopic surgery in the perioperative treatment of patients with T1-3N0M0 non-small cell lung cancer: a systematic review and meta-analysis. J Thorac Dis, 2018, 10(4): 2186-2195.
9. Yang HC, Cho S, Jheon S. Single-incision thoracoscopic surgery for primary spontaneous pneumothorax using the SILS port compared with conventional three-port surgery. Surg Endosc, 2013, 27(1): 139-145.
10. Kutluk AC, Kocaturk CI, Akin H, et al. Which is the best minimal invasive approach for the treatment of spontaneous pneumothorax? Uniport, two, or three ports: A prospective randomized trail. Thorac Cardiovasc Surg, 2018, 66(7): 589-594.
11. Li L, Tian H, Yue W, et al. Subxiphoid vs intercostal single-incision video-assisted thoracoscopic surgery for spontaneous pneumothorax: A randomised controlled trial. Int J Surg, 2016, 30: 99-103.
12. Akter F, Routledge T, Toufektzian L, et al. In minor and major thoracic procedures is uniport superior to multiport video-assisted thoracoscopic surgery. Interact Cardiovasc Thorac Surg, 2015, 20(4): 550-555.
13. Gao S, Zhang Z, Aragón J, et al. The Society for Translational Medicine: clinical practice guidelines for the postoperative management of chest tube for patients undergoing lobectomy. J Thorac Dis, 2017, 9(9): 3255-3264.
14. Takamochi K, Imashimizu K, Fukui M, et al. Utility of objective chest tube management after pulmonary resection using a digital drainage system. Ann Thorac Surg, 2017, 104(1): 275-283.
15. 卢礼卿, 程远大, 张春芳. 单孔胸腔镜手术无胸腔引流管留置在胸外科快速康复中的应用. 中华胸部外科电子杂志, 2017, 4(3): 159-163.
16. Lu TY, Chen JX, Chen PR, et al. Evaluation of the necessity for chest drain placement following thoracoscopic wedge resection. Surg Today, 2017, 47(5): 606-610.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of uniportal video-assisted thoracoscopic surgery without chest tube in enhanced recovery after thoracic surgery

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