Uniportal video-assisted thoracic surgery in the treatment of pleural empyema

Mahmoud Ismail, Dania Nachira, Elisa Meacci, Gian Maria Ferretti, Marc Swierzy, Julianna Paulina Englisch, Ramin Raul Ossami Saidy, Svea Faber, Maria Teresa Congedo, Marco Chiappetta, Leonardo Petracca Ciavarella, Stefano Margaritora, Jens C. Rueckert

Research output: Contribution to journalArticle

Abstract

Background: The efficacy of video-assisted thoracic surgery (VATS) in the treatment of pleural empyema has recently been proven. Till today, very few works evaluated the role of uniportal-VATS (U-VATS) approach in the treatment of pleural empyema even if it currently represents the most innovative and less invasive thoracoscopic approach. We report our experience with U-VATS in the treatment of pleural empyema. Methods: A retrospective bicentric analysis of 35 consecutive patients who underwent surgical treatment of stage II and stage III pleural empyema was performed, from January 2015 to May 2017. Results: The mean age of patients was 57.26±18.29 years and 54.3% of them were males. In 85.7% of the cases, empyema was related to a complicated parapneumonic effusion; in only 5 cases it was a post-surgical consequence. All patients were treated with broad-spectrum antibiotics and subsequent target therapy for 14.62±21.76 days prior to operation and 23 patients needed the placement of a chest tube. Twenty patients (57.1%) presented with stage III, 11 patients (31.4%) stage II and 4 patients (11.4%) stage I empyema. Complete debridement and decortication were obtained in all patients through U-VATS approach and no conversion or further access was needed for any reason. No major complication was recorded. Only 2 cases of trapped lung were not responsive to surgical treatment. At a mean follow-up of 247.42±306.29 days, 33 patients (94.3%) were alive with no recurrence, 2 patients died for causes unrelated to the operation. Conclusions: According to our experience, we consider U-VATS as an adequate procedure in the treatment of "stages II and III" empyemas when the necessary surgical expertise has been achieved. Indeed, U-VATS permits an easier performance and complete debridement and decortication, with a very low risk for conversion and excellent postoperative outcomes in terms of less pain, fast recovery and cosmetic results.

Original languageEnglish
Pages (from-to)S3696-S3703
JournalJournal of Thoracic Disease
Volume10
DOIs
Publication statusPublished - Nov 1 2018

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Pleural Empyema
Video-Assisted Thoracic Surgery
Empyema
Therapeutics
Debridement
Chest Tubes
Cosmetics
Anti-Bacterial Agents

Keywords

  • Decortication
  • Pleural empyema
  • Uniportal video-assisted thoracic surgery (U-VATS)

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Uniportal video-assisted thoracic surgery in the treatment of pleural empyema. / Ismail, Mahmoud; Nachira, Dania; Meacci, Elisa; Ferretti, Gian Maria; Swierzy, Marc; Englisch, Julianna Paulina; Saidy, Ramin Raul Ossami; Faber, Svea; Congedo, Maria Teresa; Chiappetta, Marco; Ciavarella, Leonardo Petracca; Margaritora, Stefano; Rueckert, Jens C.

In: Journal of Thoracic Disease, Vol. 10, 01.11.2018, p. S3696-S3703.

Research output: Contribution to journalArticle

Ismail, M, Nachira, D, Meacci, E, Ferretti, GM, Swierzy, M, Englisch, JP, Saidy, RRO, Faber, S, Congedo, MT, Chiappetta, M, Ciavarella, LP, Margaritora, S & Rueckert, JC 2018, 'Uniportal video-assisted thoracic surgery in the treatment of pleural empyema', Journal of Thoracic Disease, vol. 10, pp. S3696-S3703. https://doi.org/10.21037/jtd.2018.05.10
Ismail, Mahmoud ; Nachira, Dania ; Meacci, Elisa ; Ferretti, Gian Maria ; Swierzy, Marc ; Englisch, Julianna Paulina ; Saidy, Ramin Raul Ossami ; Faber, Svea ; Congedo, Maria Teresa ; Chiappetta, Marco ; Ciavarella, Leonardo Petracca ; Margaritora, Stefano ; Rueckert, Jens C. / Uniportal video-assisted thoracic surgery in the treatment of pleural empyema. In: Journal of Thoracic Disease. 2018 ; Vol. 10. pp. S3696-S3703.
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AU - Swierzy, Marc

AU - Englisch, Julianna Paulina

AU - Saidy, Ramin Raul Ossami

AU - Faber, Svea

AU - Congedo, Maria Teresa

AU - Chiappetta, Marco

AU - Ciavarella, Leonardo Petracca

AU - Margaritora, Stefano

AU - Rueckert, Jens C.

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N2 - Background: The efficacy of video-assisted thoracic surgery (VATS) in the treatment of pleural empyema has recently been proven. Till today, very few works evaluated the role of uniportal-VATS (U-VATS) approach in the treatment of pleural empyema even if it currently represents the most innovative and less invasive thoracoscopic approach. We report our experience with U-VATS in the treatment of pleural empyema. Methods: A retrospective bicentric analysis of 35 consecutive patients who underwent surgical treatment of stage II and stage III pleural empyema was performed, from January 2015 to May 2017. Results: The mean age of patients was 57.26±18.29 years and 54.3% of them were males. In 85.7% of the cases, empyema was related to a complicated parapneumonic effusion; in only 5 cases it was a post-surgical consequence. All patients were treated with broad-spectrum antibiotics and subsequent target therapy for 14.62±21.76 days prior to operation and 23 patients needed the placement of a chest tube. Twenty patients (57.1%) presented with stage III, 11 patients (31.4%) stage II and 4 patients (11.4%) stage I empyema. Complete debridement and decortication were obtained in all patients through U-VATS approach and no conversion or further access was needed for any reason. No major complication was recorded. Only 2 cases of trapped lung were not responsive to surgical treatment. At a mean follow-up of 247.42±306.29 days, 33 patients (94.3%) were alive with no recurrence, 2 patients died for causes unrelated to the operation. Conclusions: According to our experience, we consider U-VATS as an adequate procedure in the treatment of "stages II and III" empyemas when the necessary surgical expertise has been achieved. Indeed, U-VATS permits an easier performance and complete debridement and decortication, with a very low risk for conversion and excellent postoperative outcomes in terms of less pain, fast recovery and cosmetic results.

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