Dataset Information

Efficacy of avoiding chest drains after video-assisted thoracoscopic surgery wedge resection: protocol for a randomised controlled trial.

ABSTRACT:

Introduction

The use of routine postoperative chest drains after video-assisted thoracoscopic surgery (VATS) of the lung is a practice based on tradition with the aim of draining fluid and air. However, new evidence suggests that chest drains can be avoided in selected cases. With this randomised controlled trial, we wish to establish the efficacy and safety of avoiding postoperative chest drains compared with routine postoperative chest drains.

Methods and analysis

This is a two-centre randomised controlled trial without allocation concealment, but where randomisation occurs after the end of procedure leaving operative personnel blinded during surgery. The sample size is calculated to show a difference in pain measurements using the Numeric Rating Scale under different circumstances and at different time points to show superiority of the intervention. The trial is pragmatic by design to reflect the daily clinical scenario and with the aim of increasing the external validity of the results.

Ethics and dissemination

Approval by the local ethics committees has been obtained for both sites. The study was registered with ClinicalTrials.gov (NCT05358158) prior to inclusion. The results of the trial will be disseminated by publication in an international journal and presentation at major international thoracic surgical meetings.

Article summary

This is a randomised controlled trial estimating the effects of avoiding a chest drain after VATS wedge resection of the lung on pain, total morphine use, quality of life and complications.

Trial registration number

NCT05358158.

SUBMITTER: Holbek BL

PROVIDER: S-EPMC10882330 | biostudies-literature | 2024 Feb

REPOSITORIES: biostudies-literature

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Publications

Efficacy of avoiding chest drains after video-assisted thoracoscopic surgery wedge resection: protocol for a randomised controlled trial.

Holbek Bo Laksáfoss BL Huang Lin L Christensen Thomas Decker TD Bendixen Morten M Hansen Henrik Jessen HJ Kehlet Henrik H Petersen Rene Horsleben RH

BMJ open 20240220 2

<h4>Introduction</h4>The use of routine postoperative chest drains after video-assisted thoracoscopic surgery (VATS) of the lung is a practice based on tradition with the aim of draining fluid and air. However, new evidence suggests that chest drains can be avoided in selected cases. With this randomised controlled trial, we wish to establish the efficacy and safety of avoiding postoperative chest drains compared with routine postoperative chest drains.<h4>Methods and analysis</h4>This is a two- ...[more]

PMID: 38382951

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Project description:BackgroundChest drains are routinely used after video-assisted thoracoscopic surgery (VATS) lung resections to evacuate fluid and air from the pleural space. We compared the impact of coaxial silicone (SIL) drains vs. standard polyvinyl chloride (PVC) drains on postoperative pain, drainage efficacy, and short-term treatment outcome following VATS lobectomy.MethodsThe prospective randomized study included 80 patients who underwent VATS lobectomy for lung cancer between September 2020 and June 2023. Patients were randomized into two groups based on the type of chest drain used postoperatively: 40 in the experimental group (coaxial SIL drain Fr 24) and 40 in the control group (standard PVC drain Fr 24). The researchers collecting the data and the caregivers were not blinded to the group allocation. The primary objective was to evaluate pain over the initial 2 postoperative days by assessing analgesic consumption, respiratory muscle strength [measured as maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP)], and pain intensity using the visual analog scale (VAS). MIP, MEP, and VAS were measured both at rest and during physical activity.ResultsSixty-nine patients were included in the final analysis: 35 in the experimental group and 34 in the control group. The groups were comparable in terms of drainage efficacy and short-term treatment outcome, but pain was significantly lower in the experimental group (coaxial SIL drain). Diclofenac consumption was significantly lower in the experimental group (P=0.004), with a trend toward lower consumption of other analgesics. All respiratory muscle strength measurements were higher in the experimental group, with significant differences in static MIP on the second postoperative day (P=0.046), both static (P=0.02) and dynamic (P=0.050) MEP on the first postoperative day, and static MEP on the second postoperative day (P=0.02). Static VAS (S-VAS) on the first postoperative day was statistically significantly lower in the experimental group (P=0.003). Dynamic VAS (D-VAS) was comparable between the groups.ConclusionsThis study confirmed the hypothesis that coaxial SIL drains, owing to their softer material, cause less pain while maintaining efficacy comparable to standard PVC drains.Trial registrationThe study was registered at ClinicalTrial.gov (NCT06425601).

Project description:ObjectivesLu's approach for video-assisted thoracoscopic surgery (LVATS), which derives from UVATS, is a novel surgical approach for VATS and carries out micro-innovation for lung cancer resection. The objective of this study is to elucidate the safety, feasibility, and efficacy of this novel surgical approach.MethodsThe clinical data of patients with non-small cell lung cancer (NSCLC) who underwent a curative thoracoscopic lobectomy between Mar. 2021 and Mar. 2022, were retrospectively collected, and analyzed. According to whether applied Lu's approach during the VATS operation, patients were divided into the LVATS group and the UVATS group. The propensity score (PS) matching method was used to reduce selection bias by creating two groups. After generating the PSs, 1:1 ratio and nearest-neighbor score matching was completed. Perioperative variables, including the operation time, intraoperative blood loss, lymph node stations dissected, total drainage volume, drainage duration, postoperative hospital stay, pain score (VAS, Visual Analogue Scale) on the postoperative first day (POD1) and third day (POD3), and incidence of postoperative complications, were compared between the two groups. The data were analyzed statistically with P<0.05 defined as statistically significant.ResultsA total of 182 patients were identified, among whom 86 patients underwent LVATS and 96 UVATS. Propensity matching produced 62 pairs in this retrospective study. There were no deaths during perioperative period. Patients in the LVATS group experienced a shorter operation time (88 (75, 106) VS 122 (97, 144)min, P <0.001), less intraoperative blood loss(20 (20, 30) VS 25 (20, 50)ml, P = 0.021), shorten incision length (2.50 (2.50, 2.50) VS 3.00 (3.00, 3.50)cm, P <0.001), and more drainage volume (460 (310, 660) VS 345 (225, 600)ml, P = 0.041) than patients in the UVATS group. There was not significant difference in the lymph node stations dissected(5 (4, 5) VS 5 (4, 5), P = 0.436), drainage duration (3 (3, 4) VS 3 (3, 4)days, P = 0.743), length of postoperative hospital stay (4 (4, 5) VS 4 (4, 6)days, P = 0.608), VAS on the POD1(4 (4, 4) VS 4 (4, 4), P = 0.058)and POD3 (3 (3, 4) VS 4 (3, 4), P = 0.219), and incidence of postoperative complications (P = 0.521) between the two groups.ConclusionsLu's approach is a safe and feasible approach for video-assisted thoracoscopic surgery for the lobectomy of NSCLC. This approach can shorten surgical time, reduce incision length and intraoperative blood loss.

Project description:BackgroundAlthough chest tube-omitted video-assisted thoracoscopic surgery (VATS) has been proven to be safe and efficacious, its universal application is precluded by a varying morbidity rate due to a lack of standardization. Since digital chest drainage has already shown improved accuracy and consistency in the management of postoperative air leak, we incorporated it in the strategy of intraoperative chest tube withdrawal, aiming to achieve better results.MethodsWe collected the clinical data of 114 consecutive patients who underwent elective uniportal VATS pulmonary wedge resection at the Shanghai Pulmonary Hospital from May 2021 to February 2022. Their chest tubes were withdrawn intraoperatively after an air-tightness test facilitated by digital drainage: the end flow rate had to be kept ≤30 mL/min for >15 s at the setting of -8 cmH2O suctioning. The recordings and patterns of the air suctioning process were documented and analyzed as potential standards of chest tube withdrawal.ResultsThe mean age of the patients was 49.7±11.7 years. The mean size of the nodules was 1.0±0.2 cm. The location of the nodules encompassed all lobes, and 90 (78.9%) patients received preoperative localization. The postoperative morbidity and mortality rates were 7.0% and 0%, respectively. Six patients had clinically overt pneumothorax and two patients had postoperative bleeding that required intervention. All of the patients recovered on conservative treatment except for one case of pneumothorax that required additional tube thoracostomy. The median length of postoperative stay was 2 days; and the median time of suctioning, peak flow rate, and end flow rate were 126 s, 210 mL/min, and 0 mL/min, respectively. The median numeric rating scale for pain was 1 on postoperative day (POD) 1 and 0 on the day of discharge.ConclusionsChest tube-free VATS assisted by digital drainage is feasible with minimal morbidity. Its strength of quantitative air leak monitoring produces important measurements for the prediction of postoperative pneumothorax and future standardization of the procedure.

Dataset Information

Efficacy of avoiding chest drains after video-assisted thoracoscopic surgery wedge resection: protocol for a randomised controlled trial.

Introduction

Methods and analysis

Ethics and dissemination

Article summary

Trial registration number

Publications

Efficacy of avoiding chest drains after video-assisted thoracoscopic surgery wedge resection: protocol for a randomised controlled trial.

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