Tubeless video-assisted thoracoscopic surgery in mediastinal tumor resection

Weixue Cui; Danxia Huang; Hengrui Liang; Guilin Peng; Mengyang Liu; Run Li; Xin Xu; Jianxing He

doi:10.21037/gs-20-682

Tubeless video-assisted thoracoscopic surgery in mediastinal tumor resection

Gland Surg. 2021 Apr;10(4):1387-1396. doi: 10.21037/gs-20-682.

Authors

Weixue Cui¹, Danxia Huang¹, Hengrui Liang¹, Guilin Peng¹, Mengyang Liu¹, Run Li¹, Xin Xu¹, Jianxing He¹

Affiliation

¹ Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.

Abstract

Background: It has been reported that tubeless video-assisted thoracoscopic surgery (tubeless-VATS) is feasible and safe for thoracic diseases. Herein, we compared the early outcomes of mediastinal lesion resection between the tubeless and traditional VATS.

Methods: Clinical data of all patients who underwent thoracoscopic mediastinal tumor resection were retrospectively collected. The study involved two groups: tubeless and traditional VATS group. Propensity score matching (PSM) was applied to eliminate the population bias. Intraoperative and postoperative variables were compared among matched cohorts.

Results: In total, 43 patients in the tubeless group and 231 patients in the traditional VATS group were included. After 1:1 PSM, baseline characteristics were comparable. Anesthesia time (177.63 vs. 202.53 min; P=0.004) was shorter in tubeless group, while operation time (90.95 vs. 101.47 min; P=0.109) was similar. Overall, the total postoperative morbidity rate was similar in the two groups (15% vs. 12.5%; P=0.556). Specially, 4/43 patients in tubeless VATS group need to be re-put chest tubes postoperatively. A significant lower similar level of visual analogue scale score was observed in tubeless VATS group (1.73±0.48 vs. 3.41±0.87, P<0.001) in postoperative day 1. Meanwhile, the number of patients using postoperative opioid analgesia was also lower in tubeless VATS group (22.88% vs. 48.38%, P=0.016). Furthermore, hospital duration after surgery (2.58 vs. 5.47 days; P=0.002) was shorter in tubeless group.

Conclusions: Compared with traditional VATS, tubeless VATS for mediastinal tumor may shorten the anesthesia time, decrease postoperative pain and fasten postoperative recovery in carefully selected patients.

Keywords: Tubeless; mediastinal tumor; video-assisted thoracoscopic surgery (VATS).