We describe how 2-window video-assisted thoracoscopic decortication and lung mobilization can provide definitive management of stage III empyema. This technique was used in 52 patients with stage III empyema. None required additional ports or a thoracotomy. Three patients (6%) needed computed tomography-guided drainage of persistent large loculi, but none required further surgery. Chest radiographs at 6 weeks after surgery confirmed full lung expansion and resolution of pleural collection in the other 49 patients (94%).

There may be conflict between the requirements of surgical training and those of the clinical service if training has an impact on clinical outcomes. One area of potential impact is perioperative blood loss. We compared total and 12-hour blood loss after 2,079 consecutive cardiac operations performed over 2 years by trainees and consultants. One- and two-way analyses of variance with EuroSCORE and surgeon status as factors were carried out to evaluate the impact of surgeon status on blood loss. There was no difference in blood loss between consultants and trainees. We also compared the rates between consultants and trainees of patients returning to the operating room due to bleeding. This showed a significant difference, with trainees having a higher rate of investigation for bleeding. Cardiac surgical training can be achieved without an adverse effect on blood loss, but it may be associated with a higher rate of re-intervention for bleeding.