Uniportal thoracoscopic decortication for pleural empyema and the role of ultrasonographic preoperative staging†

Bongiolatti, Stefano; Voltolini, Luca; Borgianni, Sara; Borrelli, Roberto; Tancredi, Giorgia; Viggiano, Domenico; Gonfiotti, Alessandro

doi:10.1093/icvts/ivw423

Cited by 15 publications

(23 citation statements)

References 22 publications

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“…Chest tube duration was similar to that reported in literature for traditional VATS and lower than that for thoracotomy (5). Hospital stay was longer in our series as compared to others reported in literature (17), probably because of the clinical conditions and comorbidities of our patients that required intensive care treatment in 40% of cases and in the 20% for more than 5 days. Postoperative results were very satisfactory in terms of clinical outcomes, postoperative pain and cosmetic results.…”

Section: Discussionsupporting

confidence: 85%

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

et al. 2018

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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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Section: Discussionsupporting

confidence: 85%

“…Nevertheless, no paper has ever specifically evaluated the role of the technique in the treatment of different stage empyemas, assessing clinical outcomes, except a recent one by Bongiolatti and colleagues (17). They reported their experience with ultrasonographic preoperative staging followed by U-VATS decortication for pleural empyema.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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“…In agreement with many reports, VATS decortication is feasible and safe alternative, as it provides a better visualization of the entire pleural cavity. It is associated with lower morbidity rate, lower cost, shorter hospital stay, and good postoperative functional, and cosmetic outcomes compared to standard thoracotomy approach 3, 5. Obliterated pleural space is a major obstacle in preforming VATS and the conversion to conventional open decortication is considered in many cases 3…”

Section: Discussionmentioning

confidence: 99%

“…It is preferred to conventional three ports VATS when it comes to morbidity and patient comfort. This leads to single intercostal trauma, better cosmetics, and minimal infection spread to the chest wall in patient with empyema 5, 6. In U‐VATS, multiple endoscopic instruments and the camera are inserted through a single incision without spreading the ribs.…”

Section: Discussionmentioning

confidence: 99%

Single incision VATS decortication for 3rd stage empyema

Aljehani

Alabkary

2018

Clinical Case Reports

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“…Compared with thoracotomy, VATS has less bleeding, smaller trauma, shorter hospital stay, smaller surgical wound, and smaller scar; however, it is difficult to treat stage III empyema with VATS. [20] In conclusion, although there are some differences between thoracotomy and VATS, both of them have been proved to be superior to medical treatment. [21] Inflammation of the empyema is not only pleural cavity pus, but also inflammation of the lungs, which is characterized by the inflammation of the endobronchial membrane and alveoli in children, or even atelectasis or necrosis of the lung parenchyma, purulent pneumothorax, and pleural bronchial fistula; all these symptoms endanger the life of children.…”

Section: Introductionmentioning

confidence: 99%

Clinical observation of bronchoscopy alveolar lavage combined with thoracoscopy in the treatment of empyema in children

Yue

Yang²,

Yang³

et al. 2019

Medicine

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The objective of this study was to investigate the therapeutic effects of bronchoscopy alveolar lavage (BAL) combined with thoracoscopy in the treatment of empyema in children.Retrospectively analyzed 174 cases of pediatric empyema treated with thoracoscopy combined with BAL from January 2010 to December 2016 in our hospital. All the cases, according to admission order, were randomly divided into 2 groups, the control group (group A), which contained 89 cases, was treated with thoracoscopy; and the experimental group (group B), which contained 85 cases, was treated with BAL combined with thoracoscopy. The results of BAL treatment, the inflammatory indexes including body temperature, total leukocyte count in peripheral blood and CRP, and the therapeutic effect and prognosis including the days of antibiotic use, hospital stay, the incidence of thoracotomy and lobectomy were compared between the 2 groups.1. There was no significant difference in inflammatory indexes between the 2 groups: body temperature ( o C), (39.06 ± 0.047 and 39.08 ± 0.050), P > .855; routine leukocyte count ( * 10^9/L), (25.93 ± 1.035 and 24.76 ± 1.019), P > .425); C-reactive protein (mg/L), (128.7 ± 6.653 and 138.6 ± 7.53), P > .328.2. The results of BAL: hyperemia and edema was detected in trachea intima of all cases, including 32 cases of purulent secretion and ulcer, 21 cases of lumen deformation and 5 cases of foreign body.3. There were statistical significances in the curative effects of the control group and the experimental group: the duration of antibiotic use (days), (21.07 ± 0.342 and 17.07 ± 0.288), P < .0001); the average hospital stay (days), (22.91 ± 0.347 and 18.79 ± 0.287), P < .0001; secondary surgery (thoracotomy), 15 cases in the control group, 5 cases in the experimental group, P < .023; lung lobectomy (disability rate), 13 cases in the control group and 3 cases in the experimental group, P < .011.There was statistical difference in all the therapeutic indexes (P < .05). Bronchoscopy alveolar lavage combined with thoracoscopy has a higher success rate in the treatment of pediatric empyema, and is more comprehensive, safe and effective in controlling inflammation.Abbreviations: BAL = bronchoscopy alveolar lavage, VATS = video-assisted thoracic surgery.

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Uniportal thoracoscopic decortication for pleural empyema and the role of ultrasonographic preoperative staging†

Abstract: Uniportal thoracoscopic decortication for pleural empyema is a safe and effective approach for selected patients based on a combination of clinical and imaging staging. US patterns well corresponded with intraoperative pleural findings and showed a prognostic value.

Cited by 15 publications

References 22 publications

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

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

Single incision VATS decortication for 3rd stage empyema

Clinical observation of bronchoscopy alveolar lavage combined with thoracoscopy in the treatment of empyema in children

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