Uniportal video-assisted thoracoscopy is a safe approach in patients with empyema requiring surgery

Abstract

Background: Empyema is a well-known complication of pneumonia, with high morbidity and mortality rates. This warrants direct treatment either with antibiotics and chest tube drainage or surgery. With less invasive surgical approaches such as uniportal video-assisted thoracoscopic surgery (uVATS), surgical intervention gets a more prominent role early on in the treatment of empyema. The aim of this study was to compare uVATS with the complete VATS (cVATS) approach in empyema, with respect to postoperative complications, hospital length of stay and mortality.Methods: All cases of empyema that were treated surgically in our hospital between 2006 and 2019 were included in a retrospective database. The preferential surgical approach changed from cVATS from 2006 to 2015, towards uVATS from 2016 and on, based on the experience of the surgical team. The database included pre-and postoperative data, as well as peropartive characteristics.Results: One hundred and thirty-seven patients were treated with cVATS and 49 with uVATS. Apart from a slightly reduced kidney function in the uVATS group (57.3±6.3 vs. 71.4±17.2 mL/min/1.73 m 2 , P≤0.001), there were no significant baseline differences in patient characteristics. The duration of uVATS was comparable to cVATS (70±17 vs. 56±23 min, P=0.240), and with low per-and postoperative complications.The postoperative hospital stay was equal in both groups (19±13 vs. 20±15 days, P=0.320). There were no statistically significant differences in postoperative complications or death.Conclusions: Uniportal VATS is a feasible and safe technique for the use in patients with empyema requiring surgery. Even if decortication in stage III empyema is required this can be performed by uniportal VATS.

Spectrum of Microorganisms, Antibiotic Resistance Pattern, and Treatment Outcomes Among Patients With Empyema Thoracis: A Descriptive Cross-Sectional Study From the Bahawal Victoria Hospital Bahawalpur, Punjab, Pakistan

“…The probable reason for high success rate in the UK study might be due to the less severity of the disease and use of targeted antibiotics earlier (56,57). We found that the mortality rate in this study was 10% which was comparable with the study of Netherland (8%) (58). However, another study conducted in Pakistan reported relatively less mortality rate (1.3%) (25).…”

Uniportal video-assisted thoracoscopic surgery in a two-year-old chronic empyema patient: challenges faced in the first case from the Indian subcontinent

“…Recently, U-VATS has been used in various complex thoracic procedures in pediatric patients, primarily across advanced countries and set-ups with success. Recent literature shows a satisfactory result for U-VATS, even for stage III empyema in adult patients [10]. We believe that the successful and safe management of OLV using a single-lumen tube for…”

Minimally invasive treatment of an amebic empyema secondary to the transdiaphragmatic rupture of a liver abscess: a case report

“…Van Middendorp et al. [ 9 ] compared both techniques and found no significant difference regarding surgical outcomes. However, procedural duration of uVATS was longer compared with that of cVATS.…”