Related Experiment Videos
[Thoracoscopic treatment of pleural empyema]
E Förster1, L Gandawidjaja, T Hau
1Klinik für Allgemein-, Thorax- und Gefässchirurgie, Nordwest-Krankenhaus, Sande.
Abstract:
From August 1991 to May 1997 46 patients with pleural empyema in the fibrinopurulent phase underwent thoracoscopic surgery. There were 36 men and 10 women with an average age of 47 years ranging from 18 to 84. The average operating time was 77 minutes. When only one thoracostomy drain was inserted, the drainage time was 8.5 days, if two or three drainage tubes were used it was 10.5 days. The average hospital stay was 18.1 day (range from 7 to 45). We observed ten complications. Four operations had to be converted to an open procedure because of massive thickening and fibrosis of the pleura. Three patients did not tolerate one lung ventilation, once the lung did not collapse due to technical reasons and in one patient each we observed a laceration of the parenchyma and bleeding from the parenchyma. In both cases the problem was dealt with thoracoscopically. We observed a recurrent pleural empyema in four patients which occurred between the 28th and 77th postoperative day. In summary, thoracoscopic surgery in patients with pleural empyema in the fibrinopurulent phase is an effective and well tolerated alternative to open thoracotomy.
Insights
Thoracoscopic surgery is an effective treatment for pleural empyema in the fibrinopurulent phase. This minimally invasive approach offers a well-tolerated alternative to open thoracotomy, with manageable complications and good outcomes.
Area of Science:
- Thoracic Surgery
- Pulmonology
- Infectious Diseases
Context:
- Pleural empyema, particularly in the fibrinopurulent stage, presents a significant clinical challenge.
- Traditional treatment often involves open thoracotomy, which can be associated with substantial morbidity.
- Minimally invasive techniques are increasingly explored to improve patient outcomes.
Purpose:
- To evaluate the efficacy and safety of thoracoscopic surgery for pleural empyema in the fibrinopurulent phase.
- To compare outcomes, including operating time, drainage duration, and hospital stay, with historical data or alternative procedures.
- To assess the complication rates and recurrence of empyema following thoracoscopic intervention.
Summary:
- A study of 46 patients with fibrinopurulent pleural empyema treated with thoracoscopic surgery between 1991 and 1997.
- Average operating time was 77 minutes; drainage time varied with the number of drains (8.5 days for one, 10.5 days for 2-3).
- Average hospital stay was 18.1 days, with a 22% complication rate including four conversions to open procedures and four cases of recurrent empyema.
Impact:
- Thoracoscopic surgery demonstrates effectiveness and good tolerance as an alternative to open thoracotomy for pleural empyema.
- Findings support the adoption of minimally invasive thoracoscopic procedures for specific stages of pleural empyema.
- Further research may focus on optimizing techniques to minimize complications and recurrence rates.