Uniportal thoracoscopic decortication for pleural empyema and the role of ultrasonographic preoperative staging†. (19th January 2017)

• Record Type: Journal Article
• Authors: Bongiolatti, Stefano; Voltolini, Luca; Borgianni, Sara; Borrelli, Roberto; Tancredi, Giorgia; Viggiano, Domenico; Gonfiotti, Alessandro
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 24:Number 4(2017)
• Page Start: 560
• Page End: 566
• Publication Date: 2017-01-19
• Subjects: Pleural empyema -- Ultrasonography -- Decortication -- Uniportal-VATS surgery; Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivw423
• Languages: English
• ISSNs: 1569-9293

Abstract

Abstract: OBJECTIVES : The surgical approach to chronic pleural empyema is still controversial. Video-assisted thoracic surgery (VATS) debridement and decortication has shown favourable outcomes, while the uniportal VATS (U-VATS) approach is still anecdotal. We report our experience with ultrasonographic (US) preoperative staging followed by U-VATS decortication for pleural empyema. METHODS : We performed a retrospective analysis of patients who underwent surgical treatment of stage II and stage III pleural empyema from 2012 to 2015. Pre-, intra- and postoperative data were investigated to evaluate outcomes including postoperative complications and disease recurrence. Results were analysed according to preoperative US appearance of pleural space (stages A–E) and surgical approach (thoracotomy vs U-VATS). RESULTS : We performed 30 (47%) uniportal thoracoscopic pleural decortication and 34 (53%) open decortication for empyema in stage II (40%) or III (60%) obtaining a complete debridement and decortication in all patients. In-hospital mortality was zero and overall morbidity was 29%. U-VATS was associated with lower blood loss (118 ± 80 ml vs 247 ± 140 ml P < 0.001), lower chest tubes duration (5.6 ± 1.4 vs 10.6 ± 4.4 days P < 0.001), shorter hospital stay (6.7 ± 1.9 vs 12.2 ± 4.7 days, P < 0.001) and lower complications (10% vs 16%, P < 0.001). Elevated US patterns (D–E) are associated with thoracotomy, higher blood loss, operative time and a significant incidence of complications. CONCLUSIONS : 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.