Video-Assisted thoracoscopic surgery for pediatric empyema by two-port technique: A single-center experience with 167 consecutive cases

Abstract

Background/Purpose:The aim of our study is to determine efficacy, safety, and feasibility of video-assisted thoracoscopic surgery (VATS) in childhood empyema with a technique of only two ports and open instruments at a tertiary care center in India.Methods:This is a retrospective study of patients below 18 years, with empyema presenting to the Department of Pediatric Surgery of a Tertiary Care Referral Hospital in India, over a period of 9 years who underwent VATS decortication. Only two ports with open surgical instruments were used. The patients were assessed on the basis of mean duration of preoperative symptoms, duration of surgery, average blood loss, postoperative pain relief, complications, and need for redo surgery.Results:A total of 97 patients underwent primary VATS decortications without inserting an intercostal drainage (ICD) tube and 70 patients as a secondary procedure after ICD tube was inserted. Mean duration of symptoms was 11 days. The average blood loss during surgery was estimated to be 170 cc. The mean duration of surgery was 90 min. The most common postoperative complication was air leak seen in 19.16% of patients. Minor leaks usually settled by 24 h. In eight patients, a negative suction had to be applied to the ICD tube for persistent air leak. The average length of postoperative stay was 4 days. Two patients required a repeat open decortication procedure due to nonresolution of symptoms and poor lung expansion after VATS. Patients had minimal pain and excellent cosmetic outcome after VATS.Conclusion:Two-port VATS decortication procedure is as feasible and effective as three-port procedure for decortication with better cosmetic result and pain relief.

Video-Assisted Thoracic Surgery in Early Stage of Pediatric Pleural Empyema Improves Outcome

“…Comparing with the literature, the median in-house referral time ranges from 5 to 7 days. [13][14][15] This communication with pediatricians is very important because with early in-house referral to the pediatric surgeons patients with empyema in stage II may be treated by early VATS. Duration of hospital stay is one of the most commonly used parameters for evaluation of effectiveness of treatment.…”

“…In most cases when decortication was performed, one of the incisions has been extended to 10 to 12 mm for extraction of plaques. At the end of the procedure, a chest tube (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) Fr, depending on the patient's age and weight) was inserted under the visualization of camera and removed when drainage was less than 30 mL/day in adolescents or 10 mL/day in children. In all cases, puss and/or removed specimen (fibrin) have been sent for microbiological analysis.…”

Open pleural decortication for the late stage empyema thoracis in children: a retrospective observational study from a tertiary hospital of eastern Nepal

“…13,14 Stage II empyema can be managed effectively with VATS with rapid resolution of symptoms, hence decreasing the hospital stay and cost of the treatment. 15,16 However in our setting, patients are usually not referred in early stage (stage I and II). Furthermore, minimal invasive technology and its expertise in children is not available locally; hence, we manage with limited thoracotomy and debridement in the children with fibrinopurulent empyema requiring surgery.…”

“…[1][2][3][4][5][6][7][8][9][10] In addition, the transvaginal route, having typical physical and physiological benefits, [1][2][3][4][5][6][11][12][13][14][15][16] makes it the safest, as well as an immensely popular method. [1][2][3]6,[11][12][13][14][15][17][18][19][20][21][22][23][24][25][26] However, even a decade after its inception, it continues to be fraught with diverse technical hurdles such as spatial constraints, inadvertent vaginal gas-leak, compelling requirements for complex instrumentation, scarce availability and affordability, and a steep learning curve, to name a few. 7,[13][14][15][16][17][18][19]…”

“…[1][2][3]6,[11][12][13][14][15][17][18][19][20][21][22][23][24][25][26] However, even a decade after its inception, it continues to be fraught with diverse technical hurdles such as spatial constraints, inadvertent vaginal gas-leak, compelling requirements for complex instrumentation, scarce availability and affordability, and a steep learning curve, to name a few. 7,[13][14][15][16][17][18][19][20] Gas leaks from the vaginal…”