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Kandadai S. Rammohan
Peter A. O’Keefe
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Ann Thorac Surg 2007;84:237-239
© 2007 The Society of Thoracic Surgeons

Original Articles: General Thoracic

Is an Intercostal Chest Drain Necessary After Video-Assisted Thoracoscopic (VATS) Lung Biopsy?

Heyman Luckraz, FRCSb,*, Kandadai S. Rammohan, FRCSb, Mabel Phillips, RGNb, Rob Abel, FRCAa, Siva Karthikeyan, FRCAa, Nihal E.P. Kulatilake, FRCSb, Peter A. O’Keefe, FRCS (CTh)b

a Department of Anaesthesiology, University Hospital of Wales, Cardiff, United Kingdom
b Cardiothoracic Unit, University Hospital of Wales, Cardiff, United Kingdom

Accepted for publication March 2, 2007.

* Address correspondence to Dr Luckraz, Cardiothoracic Unit, Block C5, University Hospital of Wales, Cardiff, CF14 4XW, United Kingdom (Email: heymanluckraz{at}aol.com).

Presented at the Poster Session of the Forty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 29–31 2007.

Background: Video-assisted thoracoscopic surgical lung biopsy is a frequently performed procedure as an integral part of the diagnostic armamentarium for parenchymal lung disease. However, there is no evidence in the literature concerning the need for an intercostal chest drain after the procedure.

Methods: A prospective randomized control trial was set up to assess the need for intercostal chest drainage after video-assisted thoracoscopic surgical lung biopsy. Patients who did not have any air leak after the procedure (lung tested while patient was still under anesthetic) was randomized to either having a chest drain or not. The study was powered at 0.9 using an alpha of 0.01.

Results: Thirty patients were recruited in each group. There were no significant differences between the two groups in terms of patients’ age (mean age, 59 versus 54 years), sex, history of steroid use, immediate postoperative pain scores, and wound complications. No significant pneumothoraces occurred in either group. However in the immediate postoperative phase, 28% and 15% of patients with and without chest drains, respectively, had a small (clinically not significant) pneumothorax (size <10%) on their chest radiograph. Moreover, there was significantly increased in-hospital stay in the chest drain group (median, 3 days versus 1 day; p < 0.001). At 6 weeks’ follow-up, all patients had fully expanded lungs bilaterally.

Conclusions: There is no need for an intercostal chest drain in patients undergoing video-assisted thoracoscopic surgical lung biopsy if no air leak is identified at the time of surgery. Patients without a drain are discharged home within 24 hours postoperatively, raising the possibility of this procedure being an outpatient procedure.






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