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Efficacy, safety, and optimal timing of single-trocar video-assisted flexible thoracoscopic debridement under local anesthesia for complicated parapneumonic empyema

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Abstract

Objective

Thoracoscopic debridement under local anesthesia is a useful approach for complicated parapneumonic effusion or empyema (CPE) and is a less invasive procedure than video-assisted thoracoscopic surgery under general anesthesia. There are various methods of thoracoscopic debridement under local anesthesia, although the optimal timing of treatment is unknown. The objective of this study was to verify the efficacy and safety of our video-assisted flexible thoracoscopic debridement (VAFTS-D) procedure under local anesthesia, and to investigate the clinical features associated with the success of VAFTS-D.

Methods

The study included 71 consecutive patients with CPE who underwent VAFTS-D. The primary outcome was success of VAFTS-D. We retrospectively analyzed the efficacy and safety of VAFTS-D from the clinical data obtained from hospital medical records, and used univariate logistic analyses to identify potential predictors of the outcome.

Results

VAFTS-D was considered successful in 62 of 71 patients (87.3%). Two of the remaining nine patients died and the other seven patients required subsequent operation under general anesthesia. Complications due to VAFTS-D occurred in six patients (8.5%). Duration of empyema < 10 days (P = 0.024) and negative bacterial culture in pleural effusion (P = 0.029) were independently associated with the success of VAFTS-D by univariate logistic regression analysis.

Conclusion

VAFTS-D might be an acceptable first-line procedure in patients with suspected CPE. VAFTS-D should be performed as early as possible for a successful outcome, and to obtain useful information on the pleural cavity.

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of General Thoracic Surgery, National Hospital Organization, Higashi-Ohmi General Medical Center, 255 Gochi-cho, Higashiomi, Shiga, 527-8505, Japan

    Masatsugu Ohuchi, Shuhei Inoue & Yoshitomo Ozaki

  2. Department of Respiratory Surgery, Kohka Public Hospital, 1256 Matsuo, Minakuchi-cho, Koka, Shiga, 528-0074, Japan

    Takuya Fujita

  3. Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan

    Keiko Ueda

  4. Department of Thoracic Surgery, Ijinkai Takeda Hospital, 28-1 Isidamoriminami-cho, Kyoto-shi Fushimi-ku, Kyoto, 601-1495, Japan

    Shoji Kitamura & Yuki Namura

Authors
  1. Masatsugu Ohuchi
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  2. Shuhei Inoue
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  3. Yoshitomo Ozaki
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  4. Takuya Fujita
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Correspondence to Masatsugu Ohuchi.

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Ohuchi, M., Inoue, S., Ozaki, Y. et al. Efficacy, safety, and optimal timing of single-trocar video-assisted flexible thoracoscopic debridement under local anesthesia for complicated parapneumonic empyema. Gen Thorac Cardiovasc Surg 70, 634–641 (2022). https://doi.org/10.1007/s11748-022-01780-z

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  • DOI: https://doi.org/10.1007/s11748-022-01780-z

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