Treatment of Bilateral Empyema Thoracis Using Unilateral Single-Port Thoracoscopic Approach

Chen, Chih‐Hao; Lin, Wei-Sha; Chang, Ho; Lee, Shih-Yi; Hung, Tzu-Ti; Tai, Chih-Yin

doi:10.5761/atcs.nm.13-00051

Cited by 3 publications

(2 citation statements)

References 9 publications

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“…Thoracoscopy for empyema is usually performed through two to four incisions in the chest [3, 15, 17-19, 20, 24, 26, 27]. But there are few centers who are trying to make a single-port VATS for empyema [25] and even for bilateral empyema [28]. The trocars used are usually 10-12 mm in diameter [20,24,27].…”

Section: Discussionmentioning

confidence: 99%

Sėkmingas minimaliai invazinis chirurginis pleuros empiemos gydymas

Jagelavičius¹,

Jovaišas²,

Kybartas³

et al. 2014

LCH

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Įvadas / tikslasPleuros empiema – viena iš seniausiai žinomų krūtinės ligų ir iki šiol yra susijusi su didėjančiu sergamumu visame pasaulyje. Kaip ir daugelyje chirurgijos sričių, gydant pūlinėmis pleuros ligomis sergančius ligonius populiarėja minimaliai invazinės chirurginės procedūros. Tačiau torakoskopinė operacija vis dar negali pakeisti atvirosios visais empiemų atvejais. Šiame straipsnyje supažindiname su mūsų atliekamų torakoskopinių pleuros empiemos operacijų metodika ir aptariame pradinę patirtį.Ligoniai ir metodaiNuo 2011 m. sausio iki 2013 m. rugsėjo torakoskopiškai buvo operuoti 49 ligoniai, sergantys pleuros empiema. Visi pacientai operuoti sukėlus bendrinę nejautrą, naudojant vieno plaučio ventiliaciją. Visos torakoskopinės operacijos buvo padarytos per dvi arba tris angas krūtinėje. Tais atvejais, kai sėkmingai atlikti torakoskopiniu būdu empiemektomijos nepavykdavo, būdavo pereinama į atvirąją (torakotominę) operaciją.RezultataiSėkmingai videotorakoskopinė operacija buvo atlikta 36 (73,5 %) ligoniams, o 13 (26,5 %) atvejų prireikė konversijos į atvirą operaciją. Pleuros ertmės sąaugos ir negalėjimas iki galo pašalinti ant plaučio paviršiaus susidariusio jį kaustančio šarvo buvo pagrindinės konversijų priežastys. Dešimt (20 %) ligonių patyrė tokių pooperacinių komplikacijų kaip ligos atkrytis, ilgesnį laiką besiskiriantis pro drenus oras, žaizdos infekcija.IšvadosPleuros empiemos atveju minimaliai invazinė chirurgija yra saugi ir pakankamai efektyvi. Tačiau turėtume ieškoti tam tikrų veiksnių, kurie padėtų atrinkti asmenis, tinkamus sėkmingai torakoskopinei pleuros empiemos operacijai.Reikšminiai žodžiai: pleuros empiema, piotoraksas, videoasistuojamoji krūtinės chirurgija, empiemektomija, dekortikacija Successful video-assisted thoracic surgery for pleural empyemaŽymantas Jagelavičius, Vytautas Jovaišas, Algis Kybartas, Arūnas Žilinskas, Lina Lukoševičiūtė, Ričardas Janilionis, Narimantas Evaldas Samalavičius Background / ObjectiveFew thoracic conditions present such a considerable challenge as does pleural empyema. The disease is known since Hippocrates’ time, nonetheless it is still associated with the rising incidence all over the world. Minimally invasive procedures become more and more popular in many fields of surgery as well as in patients with pleural empyema. However, video-assisted thoracoscopy cannot replace open surgery in all empyema cases. In this report, we would like to present our thoracoscopic technique and preliminary experience in treating patients with pleural empyema.Patients and methodsDuring the period from January 2011 till September 2013, thoracoscopic empyemectomy was performed in 49 patients. All patients were operated on under general anaesthesia using single lung ventilation. All procedures were performed through two or three ports. Conversion to thoracotomy was performed when it was impossible to make successfully thoracoscopic empyemectomy.ResultsA video-assisted thoracoscopic operation was successful in 36 (73.5%) patients, whereas in 13 (26.5 %) cases a conversion was required. Pleural space adhesions and inability to remove completely the peel from the underlying lung were the main reasons for conversion. Ten (20%) patients had postoperative complications such as recurrence of disease, prolonged air leak, or wound infection.ConclusionsMinimally invasive surgery is a safe and effective treating of patients with pleural empyema. However, we should search for preoperative factors of identifying the right persons who could be cured successfully by video-assisted thoracoscopic surgery.Key words: pleural empyema, pyothorax, video-assisted thoracic surgery, empyemectomy, debridement, decortication

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Section: Discussionmentioning

confidence: 99%

Sėkmingas minimaliai invazinis chirurginis pleuros empiemos gydymas

Jagelavičius¹,

Jovaišas²,

Kybartas³

et al. 2014

LCH

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“…In the past decade, an increasing number of reports focusing on the applications of uniportal VATS in thoracic procedures has been published (8)(9)(10)(11). Despite its seemingly less minimally invasive nature, whether there are differences in outcomes of uniportal VATS compared with multiportal VATS is controversial (12)(13)(14).…”

Section: Discussionmentioning

confidence: 99%

Single-stage bilateral pulmonary resections by video-assisted thoracic surgery for multiple small nodules

Yao¹,

Yang²,

Zhao³

2016

J. Thorac. Dis.

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Background: Surgical treatment is thought to be the most effective strategy for multiple small nodules.However, in general, one-stage bilateral resection is not recommended due to its highly invasive nature.Methods: Clinical records of patients undergoing one-stage bilateral resections of multiple pulmonary nodules between January 2009 and September 2014 in a single institution were retrospectively reviewed.Results: Simultaneous bilateral pulmonary resection by conventional video-assisted thoracic surgery (VATS) was undertaken in 29 patients. Ground glass opacity (GGO) accounted for 71.9% (46/64) of total lesions, including 26 pure GGO and 20 mixed GGO lesions. One case underwent bilateral lobectomy that was complicated by postoperative dyspnea. Lobar-sublobar (L/SL) resection and bilateral sublobar resection (SL-SL) were conducted in 16 and 12 cases, respectively, and most of these cases had uneventful postoperative courses.There was no significant difference with regard to postoperative complications (P=0.703), duration of use of chest drains (P=0.485), between one-and two-stage groups. Mean postoperative follow-up in cases of primary lung cancer was 31.4 (range, 10-51) months. There was neither recurrence nor deaths at final follow-up. Conclusions Materials and methods PatientsThe study was approved by the ethics committee of Shanghai Chest Hospital. During the period of Jan 1 2009 to Sep 30 2014, cases performed with various pulmonary resections at our department were retrospectively reviewed. Twenty nine cases underwent single-stage bilateral operations of multiple pulmonary nodules were identified. For comparison, 89 patients with bilateral multiple nodules who underwent two-stage operations at the same period were also reviewed. Clinical and histologic features and surgical outcomes were studied. Surgical procedureGeneral anesthesia with double-lumen endotracheal intubation was administered.Single-stage bilateral surgical treatment by video-assisted thoracic surgery (VATS) was applied based on the following rules: patients with good performance status, patient's informed consent, characteristics of multiple pulmonary foci and individual surgeon's experience. The choice of surgical types comprehensively depends on the site of tumors, the evaluation of cardiopulmonary function reserve and outcomes of intraoperative frozen sections. Single-stage resection was performed with starting on the side of the less invasive resection, such as segmentectomy and wedge resection, generally depending on the size and morphology on preoperative chest computed tomography (CT). For planed bilateral sublobar resections, the priority was given to the right side.The patient was placed in the lateral decubitus position. After a one-sided procedure, the patient was rotated to the opposite side for a second resection. Cushions were used to lift the patient to avoid kicking or compression to the contralateral chest tube during positioning. Multiple primary lung cancer was diagnosed based on Martini-Melamed criteria (3).The comp...

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Successful treatment of bilateral empyema with bilateral fistulae using free intercostal muscle flap

et al. 2021

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Background Bilateral empyema is rare and can be life-threatening. Few cases have ever been reported about bilateral empyema with fistula on both sides. We herein report a case of bilateral empyema with bilateral fistulae that was treated with a 2-stage operation. Case presentation The patient was a 40 year-old man with uncontrolled diabetes mellitus, severe emaciation and remarkably decayed teeth. On his admission, computed tomography showed bilateral pneumothorax and pleural effusion. Thoracentesis revealed a cream-colored purulent pleural effusion from both sides of the pleural cavity. Bilateral empyema with fistulae on both sides due to a ruptured lung abscess was diagnosed. 7 days after his administration, we performed the first surgery. There were 3 fistulae in the right lateral basal segment (S9), right posterior basal segment (S10), and left posterior basal segment (S10). At the first operation, the S9 fistula was directly sutured; however, the right S10 fistula could not be closed because the surrounding tissue was fragile. The left lung fistula was deep and crater-shaped; it was closed with the suturing of a plugged free muscle flap. At the second operation, the right S10 fistula was closed with the superimposition of a pedicled intercostal muscle flap. Conclusion Patients with bilateral empyema tend to be with poor general condition and, therefore, less invasive treatments are required initially. Closure of fistulae is an essential process for the treatment of empyema with fistulae. We could manage the fistulae using several techniques with 2-stage operation. Although the efficacy of using a free intercostal muscle flap to close the fistula has not been adequately verified, it is simple and less invasive and, thus, might be a useful option in cases where the patient is too ill to undergo a more invasive operation or when the surgical approach should be done in a short time

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Treatment of Bilateral Empyema Thoracis Using Unilateral Single-Port Thoracoscopic Approach

Cited by 3 publications

References 9 publications

Sėkmingas minimaliai invazinis chirurginis pleuros empiemos gydymas

Sėkmingas minimaliai invazinis chirurginis pleuros empiemos gydymas

Single-stage bilateral pulmonary resections by video-assisted thoracic surgery for multiple small nodules

Successful treatment of bilateral empyema with bilateral fistulae using free intercostal muscle flap

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