ThOracoscopic Wedge Resection Treated With Chest Tube Removal Intraoperatively

Rigshospitalet, Denmark90 enrolled

Overview

Chest tubes are used routinely although preliminary studies demonstrate the feasibility and safety of intraoperative chest drain removal. Previous studies are however either retrospective or mainly concerning benign disease. Hypothesis: Participants treated without post-operative chest tube after thoracoscopic wedge resection have less pain, better pulmonary function and similar complication profile than participants treated with standard post-operative chest tube, and could possibly be discharged earlier.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Conditions

Pain Decreased Lung Function Delayed Discharge

Interventions

A standard 28 Fr chest tube is inserted through the anterior port hole and all port holes are closed. With the tip of the chest tube below water, the pleura is emptied from air during continuous ventilation of the lungs. An air leak after 5 minutes of ventilation indicates a negative sealing test, whereas a cessation of air leak within 5 minutes indicates a positive sealing test.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Elective thoracoscopic wedge resection * Speaks and understands Danish * FEV1 \>= 60% of expected Exclusion Criteria: * Increased risk of air leak evaluated by surgeon (large adhesions, bullae, emphysema, deep resection, etc.) * Increased risk of bleeding evaluated by surgeon (high INR, anticoagulation not paused, large bleeding, etc.) * Air leak on intraoperative sealing test * Patients previously included in study * Planned intraoperative frozen section with possible lobectomy * Previously included in current study * Planned frozen section diagnostics * Previous ipsilateral anatomic lung resection

Outcomes

Primary Outcomes

Pain

Average pain expressed as area under the curve from a numeric rank score at 1, 3, 6 and 9 hours after surgery as well as daily at 8 am and 8 pm from post-operative day 1 until discharge.

Time frame: Through post-operative admission, an average of 1 day.

Secondary Outcomes

Reasons for post-operative admission

Daily evaluation of reasons for admission.

Time frame: Through post-operative admission, an average of 1 day.

Lung function

FEV1 measured preoperatively and on post-operative day 1 at 8 am.

Time frame: Up to post-operative day 1.

Reinsertion of chest tubes

Frequency of chest tube reinsertion.

Time frame: Up to post-operative day 30.

Pneumothorax

Size and frequency of pneumothorax on x-ray after removal of chest tube