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Robotic-assisted Left Pneumonectomy For Vanishing Lung Syndrome
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Benign emptying of the postpneumonectomy space
Robert E Merritt1, Scott I Reznik, Marcelo C DaSilva
1Division of Thoracic Surgery, Stanford School of Medicine, Stanford Hospitals and Clinics, Stanford, California 94305-5407, USA. merritt@stanford.edu
The Annals of Thoracic Surgery
|August 30, 2011
Summary
A sudden drop in post-lung surgery fluid may not indicate a bronchopleural fistula (BPF). In rare asymptomatic cases, this benign emptying of the postpneumonectomy space (BEPS) can resolve without invasive procedures.
Area of Science:
- Thoracic Surgery
- Pulmonary Medicine
- Surgical Complications
Background:
- A drop in postpneumonectomy fluid level typically signals bronchopleural fistula (BPF), necessitating surgery.
- However, a rare phenomenon of benign emptying of the postpneumonectomy space (BEPS) can occur in asymptomatic patients.
Purpose of the Study:
- To investigate the incidence and characteristics of BEPS.
- To determine if BEPS requires aggressive surgical intervention.
Main Methods:
- A survey of 28 surgeons was conducted after observing a case of BEPS.
- Analysis of 7 fully documented cases meeting specific criteria for BEPS (asymptomatic, negative cultures, no BPF evidence, recovery without drainage).
Main Results:
- Forty-four cases of BEPS were reported; 7 were fully documented.
- BEPS occurred between 5 and 152 days post-pneumonectomy.
- The incidence of BEPS was estimated at 0.65%, potentially linked to pneumonectomy volume.
Conclusions:
- BEPS is a previously unreported occurrence, possibly due to intrapleural pressure shifts.
- Awareness of BEPS may help surgeons avoid unnecessary open drainage procedures in select asymptomatic patients.
- Four patients meeting BEPS criteria later developed empyema, highlighting the need for careful assessment.
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