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Updated: Jun 20, 2026
03:22
Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion
Published on: November 10, 2023
Awake video-assisted pleural decortication for empyema thoracis
Federico Tacconi1, Eugenio Pompeo, Eleonora Fabbi
1Thoracic Surgery Division, Fondazione Policlinico Tor Vergata, Tor Vergata University School of Thoracic Surgery, Viale Oxford 81, 00133, Rome, Italy. tacconifederico@libero.it
Summary
Awake video-assisted pleural decortication is a feasible procedure for empyema thoracis, achieving high rates of lung re-expansion. This minimally invasive technique offers a safe and effective treatment option with reduced surgical injury.
Area of Science:
- Thoracic Surgery
- Pulmonary Medicine
- Minimally Invasive Procedures
Background:
- Empyema thoracis often requires surgical intervention.
- Traditional decortication can be associated with significant morbidity.
- Awake surgical techniques are emerging as alternatives to general anesthesia.
Purpose of the Study:
- To assess the feasibility and outcomes of video-assisted pleural decortication performed in awake patients with empyema thoracis.
- To evaluate technical aspects and patient results, including lung re-expansion and perioperative parameters.
Main Methods:
- Retrospective analysis of 19 patients undergoing awake video-assisted thoracoscopic pleural decortication or lateral thoracotomy.
- Procedures performed under epidural anesthesia or paravertebral blocks.
- Analysis of perioperative data, including lung re-expansion, hospital stay, morbidity, and physiological variables.
Main Results:
- Successful lung re-expansion in 95% of patients.
- No intraoperative deterioration in oxygenation or need for general anesthesia conversion.
- Low morbidity and mortality rates, with an average hospital stay of 6 days.
- Significant reduction in postoperative pain levels.
Conclusions:
- Awake video-assisted pleural decortication is a feasible and effective treatment for empyema thoracis.
- The technique results in satisfactory lung re-expansion and minimal surgical injury.
- Spontaneous ventilation may aid in accurate plane identification and dissection.
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