Abstract
Background
The use of video-assisted thoracic surgery (VATS) in the treatment of pleural empyema has been proposed since the early 1990s, but among surgeons, its use varies considerably, and the results are discordant. This report aims to provide a retrospective assessment of the authors’ experience and the literature on VATS in an effort to ascertain rational criteria for the use of this technique.
Methods
Over a period of 12 years, a total of 120 cases of pleural empyema were recorded. The patients were assessed with chest x-ray, computed tomography, ultrasound, and thoracentesis. On the basis of clearly defined clinical and radiographic parameters, 38 patients underwent VATS immediately, whereas the remaining 82 were treated initially by means of tube thoracostomy. The latter was found to be sufficient for only 10 patients. Consequently, for the remaining 72 patients, it was decided to proceed also with VATS.
Results
The procedure was performed completely by VATS in 101 patients (91.8%), whereas in 9 patients (8.2%) it was necessary to convert to thoracotomy. The postoperative course was uneventful for 98 of the 110 patients (89%), whereas the remaining 12 patients experienced complications, including one case of persistent empyema (0.9%) treated by thoracotomy. The mean chest tube duration was 6 days (range, 3–25 days). The mean postoperative hospital stay was 7.1 days (range, 5–17 days). Of the 80 patients completing a 6-month follow-up evaluation, the results were considered good for 72, moderately good for 8, and less than satisfactory for 2 patients.
Conclusions
In conclusion, the authors consider VATS to be the technique of first choice for the treatment of pleural empyema when the disease is advanced or tube thoracostomy fails. It provides excellent results with a low level of invasiveness and considerably reduces the need for thoracotomy. These results can be achieved with good videothoracoscopic experience and the use of a very precise technique.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Angelillo-Mackinley T, Lyons GA, Borboza Piedras M, Angelillo-Mackinley D (1999) Surgical treatment of postpneumonic empyema. World J Surg 23: 1110–1113
Bourous D, Antoniou KM, Chalkiadakis G, Drositis J, Petrakis I, Siafakas N (2002) The role of video-assisted thoracoscopic surgery in the treatment of parapneumonic empyema after the failure of fibrinolytics. Surg Endosc 16: 151–154
Cassina PC, Hauser M, Hillejan L, Greschuchna D, Stamatis G (1999) Video-assisted thoracoscopy in the treatment of pleural empyema: stage-based management and outcome. J Thorac Cardiovasc Surg 117: 234–238
Colice GL, Curtis A, Deslauriers J, Heffner J, Light R, Littenberg B, Sahn S, Weinstein RA, Yusen RD (2000) Medical and surgical treatment of parapneumonic empyema. Chest 18: 1158–1171
Davies RJO, Traill ZC, Gleson FV (1997) Randomized controlled trial of intrapleural streptokinase in community acquired pleural infection. Thorax 52: 416–421
Kim BY, Oh BS, Jang WC, Min YI, Park YK, Park JK (2004) Video-assisted thoracoscopic decortication for management of postpneumonic pleural empyema. Am J Surg 188: 321–324
Landreneau RJ, Keenan RJ, Hazelrigg SR, Mack MJ, Naunheim KS (1995) Thoracoscopy for empyema and hemothorax. Chest 109: 18–24
Lawrence DR, Ohri SK, Moxon RE, Townsend ER, Fountain SW (1997) Thoracoscopic debridement of empyema thoracis. Ann Thorac Surg 64: 1448–1450
Luh SP, Chou MC, Wang LS, Chen JY, Tsai TP (2005) Video-assisted thoracoscopic surgery in the treatment of complicated parapneumonic effusions or empyemas: outcome of 234 patients. Chest 127: 1427–1432
Mack MJ, Aronoff RJ, Acuff TE, Douthit MB, Bowman RT, Ryan WH (1992) Present role of thoracoscopy in the diagnosis and treatment of diseases of the chest. Ann Thorac Surg 54: 403–409
Maskell NA, Davies CV, Nunn AJ, Hedley EL, Gleeson FV, Miller R, Gabe R, Rees GL, Peto TE, Woodhead MA, Lane DJ, Darbyshire JH, Davies RJ, First Multicenter Intrapleural Sepsis Trial (MIST1) Group (2005) U.K. controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med 352: 865–874
Melloni G, Carretta A, Ciriaco P, Negri G, Varly C, Augello G, Zannini P (2004) Decortication for chronic parapneumonic empyema: results of a prospective study. World J Surg 28: 488–493
Rzyman W, Skokowski J, Romanowicz G, Lass P, Murawski M, Taraszewska M, Dziadziuszko R (2005) Lung function in patients operated for chronic pleural empyema. Thorac Cardiovasc Surg 53: 245–249
Sasaki M, Hirai S, Kawabe M, Uesaka T, Morioka K, Ihaya A, Tanaka K (2005) Triangle target principle for the placement of trocars during video-assisted thoracic surgery. Eur J Cardiothorac Surg 27: 307–312
Sendt W, Forster E, Hau T (1995) Early thoracoscopic debridement and drainage as definite treatment for pleural empyema. Eur J Surg 161: 73–76
Solaini L, Prusciano F, DiFrancesco F, Bagioni P, Poddie DB (2000) Videothoracoscopic treatment of pleural empyema. Min Chir 55: 829–833
Striffeler H, Gugger M, ImHof V, Cerny A, Furrer M, Ris HB (1998) Video-assisted thoracoscopic surgery for fibrinopurulent pleural empyema in 67 patients. Ann Thorac Surg 65: 319–323
Wait MA, Sharma S, Hohn J, Nogare AD (1997) A randomized trial of empyema therapy. Chest 111: 1548–1555
Waller DA (2002) Thoracoscopy in management of postpneumonic pleural infections. Curr Opin Pulm Med 8: 323–326
Waller DA, Rengarajan A (2001) Thoracoscopic decortication: a role for video-assisted surgery in chronic postpneumonic pleural empyema. Ann Thorac Surg 71: 1813–1816
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Solaini, L., Prusciano, F. & Bagioni, P. Video-assisted thoracic surgery in the treatment of pleural empyema. Surg Endosc 21, 280–284 (2007). https://doi.org/10.1007/s00464-006-0151-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-006-0151-z