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Modified single-port non-intubated video-assisted thoracoscopic decortication in high-risk parapneumonic empyema patients

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Abstract

Background

Parapneumonic empyema patients with coronary artery disease and reduced left ventricular ejection fraction are risky to receive surgical decortication under general anesthesia. Non-intubated video-assisted thoracoscopy surgery is successfully performed to avoid complications of general anesthesia. We performed single-port non-intubated video-assisted flexible thoracoscopy surgery in an endoscopic center. In this study, the possible role of our modified surgery to treat fibrinopurulent stage of parapneumonic empyema with high operative risks is investigated.

Methods

We retrospectively reviewed fibrinopurulent stage of parapneumonic empyema patients between July 2011 and June 2014. Thirty-three patients with coronary artery disease and reduced left ventricular ejection fraction were included in this study. One group received tube thoracostomy, and the other group received single-port non-intubated video-assisted flexible thoracoscopy surgery decortication. Patient demographics, characteristics, laboratory findings, etiology, and treatment outcomes were compared.

Results

Mean age of 33 patients (24 males, 9 females) was 76.2 ± 9.7 years. Twelve patients received single-port non-intubated video-assisted flexible thoracoscopy surgery decortication, and 21 patients received tube thoracostomy. Visual analog scale scores on postoperative first hour and first day were not significantly different in two groups (p value = 0.5505 and 0.2750, respectively). Chest tube drainage days, postoperative fever subsided days, postoperative hospital days, and total length of stay were significantly short in single-port non-intubated video-assisted flexible thoracoscopy surgery decortication (p value = 0.0027, 0.0001, 0.0009, and 0.0065, respectively). Morbidities were low, and mortality was significantly low (p value = 0.0319) in single-port non-intubated video-assisted flexible thoracoscopy surgery decortication.

Conclusions

Single-port non-intubated video-assisted flexible thoracoscopy surgery decortication may be suggested to be a method other than tube thoracostomy to deal with fibrinopurulent stage of parapneumonic empyema patients with coronary artery disease and reduced left ventricular ejection fraction.

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Author information

Authors and Affiliations

  1. Department of Surgery, Cheng Hsin General Hospital, Taipei, Taiwan

    Chen-Hao Hsiao

  2. Genome and Systems Biology Degree Program, National Taiwan University and Academia Sinica, Taipei, Taiwan

    Chen-Hao Hsiao

  3. Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung Shan S. Rd, Taipei, 10002, Taiwan

    Ke-Cheng Chen & Jin-Shing Chen

  4. Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan

    Jin-Shing Chen

  5. Division of Experimental Surgery, National Taiwan University Hospital, Taipei, Taiwan

    Jin-Shing Chen

Authors
  1. Chen-Hao Hsiao
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Correspondence to Jin-Shing Chen.

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Doctors Chen-Hao Hsiao, Ke-Cheng Chen, and Jin-Shing Chen have no conflicts of interests or financial ties to disclosure.

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Hsiao, CH., Chen, KC. & Chen, JS. Modified single-port non-intubated video-assisted thoracoscopic decortication in high-risk parapneumonic empyema patients. Surg Endosc 31, 1719–1727 (2017). https://doi.org/10.1007/s00464-016-5164-7

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  • DOI: https://doi.org/10.1007/s00464-016-5164-7

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