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Eur J Cardiothorac Surg 2006;29:639-640
© 2006 Elsevier Science NL
Letter to the Editor |
Sagrat Cor University Hospital, Thoracic Surgery Department, Viladomat 288, 08029 Barcelona, Spain
Received 18 December 2005; accepted 12 January 2006.
* Corresponding author. Tel.: +34 93 4948922; fax: +34 93 4052641. (Email: juanjofibla{at}hotmail.com).
Key Words: VATS • Diffuse parenchymal lung disease • Lung biopsy • Day-case surgery
We read with interest the article by Molnar et al. [1] on the advantages of videothoracoscopic (VATS) lung biopsy (LB) using harmonic scalpel (HS) versus the traditional endostapler in two randomized groups. The average length of the procedure was 46.9 min for endostaplers versus 30.7 min for HS (16.2 min in favor of HS). However, at chest tube removal timing this tendency changed (30.6 h after LB with endostapler and 40.2 h after LB with HS). Mean hospitalization stays were similar (7.2 days for endostaplers and 7.6 days for HS). The conclusions were that the vibration method is not inferior to the standard technique and offers a safe alternative to endostapler LB.
We do not know how many of the patients included in the study by Molnar et al. [1] were oxygen-dependent or had an acute illness that may prolong their hospital stay after LB, but a mean stay of 7 days appears to be excessive. Moreover, a mean of 5 days after chest tube removal and discharge from the hospital. It is supposed that a shorter and safer technique should permit earlier chest tube removal and reduced hospital stay than the conventional procedure; however, this study showed no improvement in these terms. In our opinion, safe chest tube removal after LB can be performed earlier, and consequently hospital stays can be reduced significantly, even with the use of common endostaplers.
Russo et al. [2], in a prospective, nonrandomized trial demonstrated that chest tube removal within 90 min of VATS lung biopsy, in selected patients, could be accomplished safely. In another study, Blewett et al. [3] did not use chest tube drainage after open lung biopsy for diagnosis of interstitial lung disease. In 32 patients no complications occurred and no patient required overnight observation or hospital admission. Chang et al. [4] reported a series of 62 patients undergoing outpatient thoracoscopic LB with 5% of admissions. They concluded that outpatient thoracoscopic LB was safe and effective. In our group we have developed a policy of early removal of chest drainage after VATS LB since 1992. Of the 146 patients included, the chest tube was removed in 135 patients (92.4%) less than an hour after the procedure. In nine patients (6.2%) the chest tube was removed 4–24 h after the procedure due to initial air-leak. In only two cases (1.4%) was the tube removed after the second postoperative day. Median hospital stay was 1.2 days (range: 0–7 days). There were 32 outpatient procedures since 2001. One patient was admitted because of air-leak. In the whole group of 146, postoperative hemothorax occurred in two patients (1.4%) and pneumothorax in three patients (2.0%). There were no re-admissions [5].
In conclusion, we think that it is positive to explore new techniques to minimize air-leaks. However, in our opinion, these developments should lead to specific goals: fewer postoperative complications and shorter hospital stay which in turn should result in improved cost-benefits.
References
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  T. F. Molnar, I. Benko, Z. Szanto, T. Laszlo, and O. P. Horvath Reply to fibla et Al. Eur. J. Cardiothorac. Surg., April 1, 2006; 29(4): 640 - 641. [Full Text] [PDF]
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