Research Protocols

Co-investigators:
James A. Magovern, M.D.

Video-assisted thoracoscopic surgery (VATS) has been found to be an effective and sage approach for the diagnosis and management of patients with indeterminate pulmonary nodules and interstitial lung disease. Most of these patients undergo a peripheral wedge resection of the lung with endoscopic stapling devices. Current clinical management involves leaving a chest tube in place for two to three days despite little evidence of air leak or drainage from the chest. Recent data indicates that the average hospital length of stay for patients who had undergone a thoracoscopic biopsy was 4.9 days. This study proposes that the early removal of chest tubes in specifically selected patients undergoing thoracoscopic wedge resection will decrease their length of hospital stay.

Adult patients with indeterminate pulmonary nodules or interstitial lung disease scheduled for thoracoscopic wedge resection will be identified through the Allegheny Center for Lung and Thoracic Disease. Approximately 73 patients will be enrolled in the study to achieve statistically significant differences in length of stay compared to historical controls.

Patients with chest tubes inserted intraoperatively will have them removed in the recovery room when the following parameters are met: no air leak as documented by postoperative chest X-ray;less than 100 cc. of drainage per hour; no hemothorax or pneumothorax as documented by chest X-ray; not ventilator dependent; and stable vital signs. Standard management of thoracoscopic wedge resection patients with chest tubes includes documenting the absence of air leak on a postoperative chest X-ray and, if drainage is minimal, the chest tube is removed the morning of the second or third postoperative day.

Patients' level of pain assessed by visual analogue scales and the amount of daily narcotic or analgesic required during the hospitalization will be documented. The occurrence of significant postoperative air leaks, hospital length of stay and the development of complications (i.e., chesttube reinsertion, hemothorax, empyema) will also be assessed.

Risks associated with early chest tube removal include pneumothorax, hemothorax, and the need to reinsert the chest tube after surgery. Benefits associated with early chest tube removal include reduced postoperative pain, early ambulation, decreased hospital length of stay and overall reduced hospital costs.

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