Abstract
Background. Although thoracoscopy under local anesthesia is widely used, the appropriate time for removal of the chest tube after this procedure is unknown. We prospectively studied patient toleration of chest tube removal on the same day as diagnostic thoracoscopy under local anesthesia (hereinafter called "same-day removal"). Method. The study was conducted on 30 patients with pleurisy who were determined to require thoracoscopy for further evaluation and who were aged 20-79, had a percutaneous oxygen saturation of ≥90%, pleural effusion less than half the thoracic cavity, and were judged by a pulmonologist on a previous examination to be candidate to undergo same-day removal. After the patient underwent thoracoscopy with local anesthesia, the indwelling chest tube was removed on the same day. We evaluated the surgical success rate of same-day removal, time to chest tube removal, reasons for failure of same-day removal, and complications and the incidence of pleural effusion within 1 month of the procedure. Results. From August 2009 through February 2011, we enrolled 30 consecutive patients. One of these 30 patients was excluded due to cancellation of thoracoscopy, 2 other patients were excluded because it was thought that pleurodesis was necessary at the time of thoracoscopy. And the remaining 27 patients were studied. Among these 27 patients, 13 had cancerous pleurisy, 6 had tuberculous pleurisy, 1 had chronic empyema, 1 had reactive pleurisy, and 6 had nonspecific pleurisy. Same-day removal, which averaged 5.4 hours, was successful in 26 patients (96%). Patients unsuitable for same-day removal included 1 patient who suffered pneumothorax in the contralateral lung. Complications such as subcutaneous emphysema and pneumothorax occurred, and 2 patients required removal of pleural effusion within 1 month of the procedure. Conclusion. As long as patients are chosen appropriately, same-day removal is considered to be adequately tolerable.
