No-drain management after thoracoscopic lung wedge resection with a novel intraoperative sealing test

Gen Thorac Cardiovasc Surg. 2022 Oct;70(10):900-907. doi: 10.1007/s11748-022-01815-5. Epub 2022 Apr 12.


Objective: Although previous studies have reported the safety of no-drain management after thoracoscopic wedge resection, most of those studies were non-inferiority trials. The aim of this study was to evaluate whether no-drain management with an optimal sealing test affects post-operative complications in patients after thoracoscopic wedge resection.

Methods: A total of 906 patients who underwent thoracoscopic lung wedge resection for various disorders except secondary pneumothorax between 2011 and 2020 were analyzed. According to intraoperative findings from the sealing test, patients were divided into groups with chest drain placement (Drain group, n = 514) or no-drain management (no-drain group, n = 392). Our intraoperative sealing test used a flexible drain (Blake®, 19-Fr; Ethicon, Somerville, NJ) connected to the chest drain bag (- 10 cmH2O) to monitor intrathoracic pressure and detect occult alveolar air leakage. Propensity score matching was conducted to balance baseline characteristics of the two groups and reduce selection bias.

Results: A total of 250 pairs were matched and standardized differences suggested proper matching had been achieved. Mean length of post-operative hospital stay (4.6 days vs. 3.2 days, p < 0.001) was significantly lower in the no-drain group. Total post-operative complication rates were significantly lower in the no-drain group (6.4% vs. 2.4%, p = 0.03).

Conclusions: No-drain management after thoracoscopic wedge resection was associated with fewer post-operative complications and shorter hospital stay in selected patients. Our novel intraoperative sealing test may be useful for no-drain management of select patients.

Keywords: Chest drain; ERAS; Video-assisted thoracoscopic surgery.

MeSH terms

  • Chest Tubes / adverse effects
  • Humans
  • Lung / surgery
  • Pneumonectomy* / adverse effects
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Retrospective Studies
  • Thoracic Surgery, Video-Assisted* / adverse effects