Heart, Lung and Circulation
Original Article| Volume 16, ISSUE 2, P103-106, April 2007

How Best to Manage the Space after Pneumonectomy? Theory and Experience but no Evidence


      We set out to find a policy for the management of the pneumonectomy space which would minimise risk and be acceptable to all the surgeons. We believe this will reduce opportunities for error, be welcomed by nursing staff, and improve adherence to protocols.


      We sought evidence in the scientific and educational literature. Finding no sure guidance, we audited our own experience of two policies, with the emphasis on minimising risk.


      There was no evidence from randomised trials. There was no cohesive advice in the text books. Our data indicated that it was improbable that randomised controlled trial (RCT) would have the power to find the evidence. Unable to establish the best strategy, we chose what appeared to be the lowest risk management policy.


      It is instructive that such a fundamental question should be unanswered. We have adopted a low risk and well established strategy—an unclamped underwater seal drain—but have no evidence base other than clinical experience. This is illustrative of much of what we do in clinical surgical practice. Avoiding major risk is often more important than proving small differences in benefit.


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        • Pye D.
        The nature and art of workmanship.
        Cambridge University Press, 1968
        • Treasure T.
        Do whatever works in your hands.
        Lancet. 1996; 347: 559-560
        • Laforet E.
        • Boyd T.
        Balanced drainage of the pneumonectomy space.
        Surg Gynecol Obst. 1964; : 1051-1054
        • Smith G.C.
        • Pell J.P.
        Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials.
        BMJ. 2003; 327: 1459-1461
        • Treasure T.
        The evidence on which to base practice: different tools for different times.
        Eur J Cardiothorac Surg. 2006; 30: 819-824
        • Birkmeyer J.D.
        • Stukel T.A.
        • Siewers A.E.
        • Goodney P.P.
        • Wennberg D.E.
        • Lucas F.L.
        Surgeon volume and operative mortality in the United States.
        N Engl J Med. 2003; 349: 2117-2127
        • Birkmeyer J.D.
        • Siewers A.E.
        • Finlayson E.V.
        • Stukel T.A.
        • Lucas F.L.
        • Batista I.
        • Welch H.G.
        • Wennberg D.E.
        Hospital volume and surgical mortality in the United States.
        N Engl J Med. 2002; 346: 1128-1137
        • Anyanwu A.C.
        • Treasure T.
        Surgical research revisited: clinical trials in the cardiothoracic surgical literature.
        Eur J Cardiothorac Surg. 2004; 25: 299-303
        • Deslauriers J.
        • Gregoire J.
        Techniques of pneumonectomy: drainage after pneumonectomy.
        Chest Surg Clin N Am. 1999; 9: 437-447
        • Choudhry N.K.
        • Anderson G.M.
        • Laupacis A.
        • Ross-Degnan D.
        • Normand S.L.
        • Soumerai S.B.
        Impact of adverse events on prescribing warfarin in patients with atrial fibrillation: matched pair analysis.
        BMJ. 2006; 332: 141-145
        • Ayed A.K.
        Suction versus water seal after thoracoscopy for primary spontaneous pneumothorax: prospective randomized study.
        Ann Thorac Surg. 2003; 75: 1593-1596
        • Brunelli A.
        • Monteverde M.
        • Borri A.
        • Salati M.
        • Marasco R.D.
        • Al Refai M.
        • Fianchini A.
        Comparison of water seal and suction after pulmonary lobectomy: a prospective, randomized trial.
        Ann Thorac Surg. 2004; 77: 1932-1937
        • Cerfolio R.J.
        • Bass C.
        • Katholi C.R.
        Prospective randomized trial compares suction versus water seal for air leaks.
        Ann Thorac Surg. 2001; 71: 1613-1617
        • Marshall M.B.
        • Deeb M.E.
        • Bleier J.I.
        • Kucharczuk J.C.
        • Friedberg J.S.
        • Kaiser L.R.
        • Shrager J.B.
        Suction vs water seal after pulmonary resection: a randomized prospective study.
        Chest. 2002; 121: 831-835
        • Alphonso N.
        • Tan C.
        • Utley M.
        • Cameron R.
        • Dussek J.
        • Lang-Lazdunski L.
        • Treasure T.
        A prospective randomized controlled trial of suction versus non-suction to the under-water seal drains following lung resection.
        Eur J Cardiothorac Surg. 2005; 27: 391-394
        • Wolfe W.G.
        • Lewis Jr., C.W.
        Control of the pleural space after pneumonectomy.
        Chest Surg Clin N Am. 2002; 12: 565-570