The use of intercostal drainage following thoracoscopic lymph node biopsy

Introduction Mediastinal lymph node biopsy is better done by thoracoscopy as the morbidity is found to be less than with thoracotomy. It provides a clear vision of the anatomy allowing a precise dissection and haemostasis. Following surgery, the collapsed lung can be expanded under direct vision. Hence elective use of intercostal drainage which is the normal practice following open surgery is open to discussion. Avoiding intercostal drainage reduces morbidity related to its use.

Material and Methods Patients subjected to thoracoscopic mediastinal lymph node biopsy were included in the study. Haemostasis was achieved during surgery with bipolar diathermy and ultrasonic dissector. The collapsed lung was expanded under direct vision. Intercostal drainage was not used in any of the patients and a post operative chest X ray was obtained to confirm lung expansion and detect complications. Heart rate, respiratory rate and blood pressure measurements were serially recorded to monitor for complications.

Results Eight patients were subjected to surgery; no haemothorax or pneumothorax was radiologically detected during the post operative period. The variations of cardiorespiratory parameters were within normal range in all patients during the post operative period. All patients were discharged within 48 hours.

Conclusion Elective use of intercostal drainage may not be required with thoracoscopic lymph node biopsy.

The Sri Lanka Journal of Surgery 2014; 32(4): 19-21