Thoracoscopic Surgery Without Drainage Tube Placement for Peripheral Lung Nodules.

Background. Although drainage tube placement after thoracoscopic pulmonary resection is considered mandatory, the drainless approach after pulmonary resections may be feasible in selected patients. We aimed to determine whether a drainless approach is safe and associated with shorter hospital stay after thoracoscopic surgery for peripheral lung nodules. Methods. This single-center, open-label, parallel-group, prospective, randomized, controlled trial enrolled patients with peripheral lung nodules treated with uniportal thoracoscopic wedge resection. After confirming the absence of air leaks and before closing the wound, patients were allocated to receive or not receive drainage using a chest tube, according to a preestablished randomization sequence provided in sealed envelopes. The primary end point was the length of postoperative hospital stay. Results. Of 107 patients who agreed to participate in the study between August 2016 and September 2017, 100 were randomized to the drainage group (n = 50) or drainless group (n = 50) for intention-to-treat analysis. Patients in the drainless group had shorter post-operative hospital stay (mean, 1.2 versus 2.6 days; P < .001), shorter surgery duration (mean, 59.0 versus 73.7 minutes; P = .001), and lower pain on postoperative day 1 (mean, 0.9 versus 1.2 points; P = .011). In the drainless group, residual pneumothorax was noted in 31 patients at 6 hours (62%), in 18 patients at 1 day (36%), and in 1 patient at 10 to 14 days after surgery (2%). Medical costs were also substantially lower in the drainless group. Conclusions. Uniportal thoracoscopic wedge resection without drainage is feasible and safe for selected patients with peripheral lung nodules. (C) 2020 by The Society of Thoracic Surgeons