Safety of one 8.5-Fr pigtail catheter for postoperative continuous open gravity drainage after uniportal video-assisted thoracoscopic surgery pneumonectomy

Abstract

Abstract OBJECTIVES Uniportal video-assisted thoracoscopic surgery pneumonectomy (U-VATS-P) is feasible and safe from a perioperative standpoint in clinical practice. How to choose proper chest tube and drainage method is an important step in enhanced recovery after surgery (ERAS) protocols. In this study, we aimed to assess the safety of one 8.5-Fr (1Fr = 0.333mm) pigtail catheter for postoperative continuous open gravity drainage after U-VATS-P. METHODS We retrospectively reviewed a single surgeon’s experience of U-VATS-P for lung cancer from May 2016 to September 2022. Patients were managed with one 8.5-Fr pigtail catheter for postoperative continuous open gravity drainage after U-VATS-P. The clinical characteristics and perioperative outcomes of the patients were retrospectively analyzed. RESULTS In total, 77 patients underwent the placement of one 8.5-Fr pigtail catheter for postoperative continuous open gravity drainage after U-VATS-P for lung cancer. The mean age was 60.9\(\pm\)7.39 (40–76) years old; the median operative time was 191.38\(\pm\)59.32min; the mean operative hemorrhage was 109.46\(\pm\)96.56ml; the mean duration of postoperative chest tube drainage was 6.80\(\pm\)2.33 days; the mean drainage volume in the first three days after operation was 186.31\(\pm\)50.97, 321.97\(\pm\)52.03, 216.44\(\pm\)35.67ml respectively; the mean postoperative hospital stay was 7.90\(\pm\)2.58 days. No patient experienced complications resulting from chest tube malfunction. Ten patients experienced minor complications. One patient with non-life-threatening empyema and bronchopleural fistula required short rehospitalization for anti-inflammatory therapy and re-intubation. Three patients with chylothorax were treated with intravenous nutrition. Four patients had atrial fibrillation that were controlled by antiarrhythmic therapy. Two patients had more thoracic hemorrhagic exudation after operation that could be found in time and were cured effectively and discharged from the hospital uneventfully after early hemostatic therapy and nutritional support. CONCLUSIONS Insertion of one 8.5-Fr pigtail catheter for postoperative continuous open gravity drainage after U-VATS-P is a safe and effective procedure in the treatment of lung cancer without a major increase in morbidity or mortality and should be popularized.