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J Thorac Cardiovasc Surg 1998;116:371-372
© 1998 Mosby, Inc.

Letters To The Editor

Pleural tenting for upper lobectomy

Eduardo A. Tovar, MD

To the Editor:

Robinson and PrekstoGo 1 showed that obliterating the apical space with a pleural tent shortened the duration of air leaks after upper lobectomies. This in turn resulted in reduced chest tube time and length of hospital stay. I have not noticed a significant difference in air leaks when comparing upper lobectomies with lower lobectomies in my patient population. To establish whether any additional maneuver, such as pleural tenting, would be beneficial to my patients, I examined data from the last 20 consecutive patients in whom I performed upper lobe resections. These patients are part of an ongoing clinical pathway study group. For age and gender distribution, type of operation, chest tube time, and length of hospital stay, see Table I. No mortality and no significant morbidity were recorded, the mean length of hospital stay was 1.5 days, and only one of these patients had to be readmitted—a patient with severe emphysema who had a sudden episode of shortness of breath 1 week after the chest tube had been removed. A small anterior chest tube was inserted for a pneumothorax, and the patient was discharged the day after the readmission and had no further complications. Another patient had temporary vocal cord dysfunction resulting from manipulation of the left recurrent laryngeal nerve during mediastinal lymphadenectomy.


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  		Table I. Patient characteristics
 
Technically, I do not do anything out of the ordinary. I carefully dissect the fissures and complete them with surgical staplers, and all patients are extubated in the operating room.

I congratulate Robinson and Preksto for bringing to our attention pleural tenting and concur with them that it may be an invaluable tool in patients after large segmentectomies, particularly in patients with emphysematous lungs. I further agree that this method should be available for the surgeon's use, as they noted in their closing discussion.

Department of Cardiothoracic SurgerySt. Jude Medical Center, Fullerton, CA 92835The University of CaliforniaIrvine Medical Center, Orange, CA12/8/90668

References

  1. Robinson LA, Preksto D. Pleural tenting during upper lobectomy decreases chest tube time and total hospitalization days. J Thorac Cardiovasc Surg 1998;115:319-27.




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