Management of pleural empyema with single-port video-assisted thoracoscopy

The aim of this study was to evaluate the safety and efficacy of an original technique of single-port video-assisted thoracoscopy (S-VATS) for the minimally invasive treatment of pleural empyema in fibrinopurulent stage.

Single-port video-assisted thoracoscopy was performed under general anesthesia and single-lung ventilation using a 2-cm incision after ultrasound localization of the projected midpoint of the pleural effusion. Through the single access, a video scope and standard thoracoscopy instruments were simultaneously introduced to perform debridement and lavage of the pleural cavity. Postoperatively, patients underwent continuous or intermittent pleural irrigation through the chest tube until microbiological confirmation of sterility of the pleural fluid.

Between November 2004 and December 2009, a total of 61 patients underwent S-VATS for pleural empyema in stage I (7%) or II (93%). Median age was 63.5 years (range, 22-94 years). Male-to-female ratio was 4.2. Surgery was performed 3 to 60 days after the onset of symptoms. Macroscopically complete debridement of the pleural cavity was achieved in most (98%) cases. Median operation time was 53 minutes (range, 29-90 minutes). No intraoperative complications occurred. In-hospital mortality and morbidity rates were 3% and 16%, respectively. Deaths were caused by diffuse metastatic colon cancer in one case and severe apoplectic insult in the other. Chest tube was removed after a median time of 12 days (range, 4-64 days). Four (6.5%) patients experienced a relapse of empyema; this was caused by complicated residual pleural space (two cases), persistent pleuropulmonary fistula (one case), or both (one case).

It seems that S-VATS is a safe and effective procedure for the treatment of pleural empyema in fibrinopurulent stage.