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Yang Z, Chang X. A 2.5-cm single-port video-assisted thoracoscopic surgery for stage III tuberculous empyema: a case report. J Cardiothorac Surg 2023; 18:15. [PMID: 36627632 PMCID: PMC9832621 DOI: 10.1186/s13019-023-02116-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 01/02/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Stage III tuberculous empyema is a common disease of tuberculosis. Traditionally, it has been treated by thoracotomy or video-assisted thoracoscopic surgery with two to four incisions. But conventional surgery has large trauma, large bleeding volume and long recovery time. To our knowledge it is the first report of surgery for stage III tuberculous empyema with a mini single-port approach. CASE PRESENTATION A 23-year-old woman admitted to our hospital with complaints of intermittent chest pain for half a year. We got the diagnosis of stage III tuberculous empyema after medical treatment. Considering that the patient was young and unmarried, we decided to perform minimally invasive pleural decortication through a 2.5 cm single port. The operation time was 240 min, and blood loss was 100 ml. The patient recovered well and postoperative pain was mild. CONCLUSION This case demonstrates that single-port VATS with a smaller incision for the Stage III tuberculous empyema should be considered in well selected patients.
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Affiliation(s)
- Zhi Yang
- grid.24696.3f0000 0004 0369 153XDepartment of Thoracic Surgery, Beijing Chest Hospital Affiliated to Capital Medical University, Courtyard 9, Beiguan Street, Tongzhou District, Beijing, China
| | - Xiujun Chang
- grid.24696.3f0000 0004 0369 153XDepartment of Thoracic Surgery, Beijing Chest Hospital Affiliated to Capital Medical University, Courtyard 9, Beiguan Street, Tongzhou District, Beijing, China
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2
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Klausen MB, Laursen C, Bendixen M, Naidu B, Bedawi EO, Rahman NM, Christensen TD. Does the time to diagnosis and treatment influence outcome in adults with pleural infections. Eur Clin Respir J 2023; 10:2174645. [PMID: 36743828 PMCID: PMC9897775 DOI: 10.1080/20018525.2023.2174645] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Objective To investigate the effect of early diagnosis and intervention in adult patients with complicated parapneumonic pleural effusion or pleural empyema and the impact on outcomes. Methods A systematic review based on a literature search of the PubMed database was performed. Results Eleven eligible studies were included; nine observational studies and two randomised controlled trials totalling a study population of 10,717 patients. The studies were conducted from 1992 to 2018, all in Europe and Northern America except one. Results varied between studies, but a trend towards better outcome in patients with shorter duration of symptoms and quicker initiation of treatment was found. We found that duration of symptoms before treatment may affect length of hospital stay, rate of conversion to open surgery, and frequency of complications. Conclusion We found that an earlier intervention in adults suffering from complicated parapneumonic pleural effusion and pleural empyema may potentially improve the outcome of patients in terms of length of stay, conversion to open surgery, and general complications following treatment, but not regarding mortality. Further studies are required to specify the timing of each intervention, and direct comparison in early management of interventions.
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Affiliation(s)
- Mads Brögger Klausen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Morten Bendixen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Babu Naidu
- Department of Thoracic Surgery, Queen Elizabeth Hospital Birmingham, UK & Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Eihab O Bedawi
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Najib M Rahman
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Thomas Decker Christensen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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3
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The efficacy and safety of uniportal video-assisted thoracic surgery on the treatment for stage II-III tuberculous empyema: a single-arm clinical retrospective study from 2016 to 2021 in a thoracic surgery center in China. BMC Pulm Med 2022; 22:398. [PMID: 36329427 PMCID: PMC9635196 DOI: 10.1186/s12890-022-02182-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022] Open
Abstract
Background Surgery is an important adjuvant treatment for tuberculous empyema(TE). We thus conducted a single arm-clinical retrospective study of stage II-III TE patients who underwent uniportal video-assisted thoracic surgery (Uni-VATS) over a 5-year period to evaluate the efficacy and safety of surgery on TE, so as to provide the evidence for the optimal clinical strategies. Methods Patients diagnosed as TE with withdrawal of anti-tuberculosis-VATS were retrospectively enrolled from January 2016 to December 2021. All patients were followed up untill 12 months after withdrawal of anti-tuberculosis treatment (ATT). Clinical characteristics and surgical details were observed and analyzed to evaluate the efficacy and safety of the minimally invasive surgery. Results Totally 439 cases met included criteria were enrolled, no deaths were reported. The mean operative time was 2.6 (1.9, 4.3) hours and the mean intraoperative blood loss was 356 (240, 940) ml. Blood transfusion was performed in 20.50% (90/439) of patients and additional pneumonectomy was occurred in 9.89%(37/439)of patients .The mean postoperative drainage time was 12 (7, 49) days and the mean hospital stay was 6 (4,12) days. All stage II TE achieved complete lung re-expansion after surgery while 84.22%(315/374) of stage III achieved complete lung re-expansion, p 0.00. 15.78% (59/374) of stage III TE achieved incomplete re-expansion, 4 of which underwent a second decortication by Uni-VATS. Recurrences rate was 2.96% (13/439), including 11 cases of early recurrence and 2 cases of late recurrence at TE stage III, 5 of which underwent a second decortication by Uni-VATS. Conclusion Uni-VATS is highly effective safe and minimally invasive for patients with TE, which could be recommended as the mainstream operation in areas with high TB burden.
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4
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Liu X, Yang Y, Ma X, Wang X, Ma B, Li S. The Effect of CT-Guided Artificial Pneumothorax plus Thoracoscopy and Central Venous Catheterization on the Drainage Effect of Pediatric Empyema and Pulmonary Function. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:8230212. [PMID: 36110977 PMCID: PMC9448614 DOI: 10.1155/2022/8230212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/30/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022]
Abstract
The aim of the study is to investigate the effect of CT-guided artificial pneumothorax combined with a thoracoscopic and central venous catheter on empyema drainage effect and pulmonary function in children. A total of 82 pediatric patients with empyema admitted to our hospital from January 2020 to December 2021 were retrospectively analyzed. The control group was treated with artificial pneumothorax combined with thoracoscopy. The study group was treated with a CT-guided and central venous catheter. The operation time, intraoperative bleeding, surgical field exposure, WBC, C-reactive protein, and pulmonary function were compared between the two groups. The size of effusion and sonographic staging were compared between the two groups. All children underwent spirometry and a maximal incremental cardiopulmonary exercise test. The operation indicators (operation time, intraoperative blood loss, etc.) and adverse reactions were compared between the two groups. The differences in the operation time, intraoperative blood loss, postoperative hospital stay, postoperative drainage volume, and surgical field exposure between the two groups had a statistical significance (P < 0.05); the differences in the body temperature, total peripheral white blood cell count, C-reactive protein, size of effusion, and sonographic staging between the two groups had no statistical significance (P > 0.05); before operation, the differences in the expression levels of FVC (%), FEV1 (%), FEV1/FVC, and MVV (%) and indicators of cardiopulmonary function including VE/VO2, breathing reserve(%), VD/VT(%), and VO2/work between the two groups had no statistical significance, but at 6 months after operation, FVC (%), FEV1 (%), FEV1/FVC, and MVV (%) in the study group were significantly higher than those in the control group (P < 0.05) and VE/VO2 and VD/VT(%) in the study group were obviously lower than those in the control group (P < 0.05); the incidence rate of chest pain, pulmonary edema, and skin infection in the study group was lower than that in the control group (P < 0.05). CT-guided artificial pneumothorax combined with thoracoscopic and central venous catheter drainage of empyema in children is more thorough, with less bleeding, less trauma, rapid recovery of pulmonary function, and is worthy of clinical promotion.
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Affiliation(s)
- Xiaoping Liu
- Northwest University for Nationality School of Clinical Medicine, Lanzhou, China
- The Second People's Hospital of Gansu Province, Gansu, Lanzhou, China
- Affiliated Hospital of Northwest University for Nationalities, Lanzhou, China
| | - Yanxia Yang
- Northwest University for Nationality School of Clinical Medicine, Lanzhou, China
- The Second People's Hospital of Gansu Province, Gansu, Lanzhou, China
- Affiliated Hospital of Northwest University for Nationalities, Lanzhou, China
| | - Xueping Ma
- Northwest University for Nationality School of Clinical Medicine, Lanzhou, China
- Department of Respiratory and Critical Care Medicine, Second People's Hospital of Gansu Province, Gansu, Lanzhou, China
| | - Xin Wang
- Northwest University for Nationality School of Clinical Medicine, Lanzhou, China
- Department of Respiratory and Critical Care Medicine, Second People's Hospital of Gansu Province, Gansu, Lanzhou, China
| | - Bing Ma
- Northwest University for Nationality School of Clinical Medicine, Lanzhou, China
- Department of Respiratory and Critical Care Medicine, Second People's Hospital of Gansu Province, Gansu, Lanzhou, China
| | - Shuhua Li
- Northwest University for Nationality School of Clinical Medicine, Lanzhou, China
- The Second People's Hospital of Gansu Province, Gansu, Lanzhou, China
- Affiliated Hospital of Northwest University for Nationalities, Lanzhou, China
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5
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Luciani C, Scacchi A, Vaschetti R, Di Marzo G, Fatica I, Cappuccio M, Guerra G, Ceccarelli G, Avella P, Rocca A. The uniportal VATS in the treatment of stage II pleural empyema: a safe and effective approach for adults and elderly patients-a single-center experience and literature review. World J Emerg Surg 2022; 17:46. [PMID: 36038946 PMCID: PMC9423701 DOI: 10.1186/s13017-022-00438-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Pleural empyema (PE) is a frequent disease, associated with a high morbidity and mortality. Surgical approach is the standard of care for most patients with II-III stage PE. In the last years, the minimally invasive surgical revolution involved also thoracic surgery allowing the same outcomes in terms of safety and effectiveness combined to better pain management and early discharge. The aim of this study is to demonstrate through our experience on uniportal-video-assisted thoracoscopy (u-VATS) the effectiveness and safety of its approach in treatment of stage II PE. As secondary endpoint, we will evaluate the different pattern of indication of u-VATS in adult and elderly patients with literature review. Methods We retrospectively reviewed our prospectively collected database of u-VATS procedures from November 2018 to February 2022, in our regional referral center for Thoracic Surgery of Regione Molise General Surgery Unit of “A. Cardarelli” Hospital, in Campobasso, Molise, Italy. Results A total of 29 patients underwent u-VATS for II stage PE. Fifteen (51.72%) patients were younger than 70 years old, identified as “adults,” 14 (48.28%) patients were older than 70 years old, identified as “elderly.” No mortality was found. Mean operative time was 104.68 ± 39.01 min in the total population. The elderly group showed a longer operative time (115 ± 53.15 min) (p = 0.369). Chest tube was removed earlier in adults than in elderly group (5.56 ± 2.06 vs. 10.14 ± 5.58 p = 0.038). The Length of Stay (LOS) was shorter in the adults group (6.44 ± 2.35 vs. 12.29 ± 6.96 p = 0.033). Patients evaluated through Instrumental Activities of Daily Living (IADL) scale returned to normal activities of daily living after surgery. Conclusion In addition, the u-VATS approach seems to be safe and effective ensuring a risk reduction of progression to stage III PE with a lower recurrence risk and septic complications also in elderly patients. Further comparative multicenter analysis are advocated to set the role of u-VATS approach in the treatment of PE in adults and elderly patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13017-022-00438-8.
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Affiliation(s)
- Claudio Luciani
- General Surgery Unit, A. Cardarelli Hospital, Campobasso, CB, Italy
| | - Andrea Scacchi
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Roberto Vaschetti
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | | | - Ilaria Fatica
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Micaela Cappuccio
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Germano Guerra
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Graziano Ceccarelli
- General and Robotic Surgery Department, San Giovanni Battista Hospital, Foligno, Perugia, Italy
| | - Pasquale Avella
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy.
| | - Aldo Rocca
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
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6
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van Middendorp LB, Franssen S, Gillissen S, Maessen JG, Hulsewé KWE, Vissers YLJ, de Loos ER. Uniportal video-assisted thoracoscopy is a safe approach in patients with empyema requiring surgery. J Thorac Dis 2020; 12:1460-1466. [PMID: 32395283 PMCID: PMC7212173 DOI: 10.21037/jtd.2020.02.29] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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 m2, 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.
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Affiliation(s)
- Lars B van Middendorp
- Department of Surgery, Division of Thoracic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands.,Department of Cardiothoracic Surgery, Maastricht UMC+, Maastricht, The Netherlands
| | - Stijn Franssen
- Department of Surgery, Division of Thoracic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Sanne Gillissen
- Department of Surgery, Division of Thoracic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht UMC+, Maastricht, The Netherlands
| | - Karel W E Hulsewé
- Department of Surgery, Division of Thoracic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Yvonne L J Vissers
- Department of Surgery, Division of Thoracic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Erik R de Loos
- Department of Surgery, Division of Thoracic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
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7
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Cargill TN, Hassan M, Corcoran JP, Harriss E, Asciak R, Mercer RM, McCracken DJ, Bedawi EO, Rahman NM. A systematic review of comorbidities and outcomes of adult patients with pleural infection. Eur Respir J 2019; 54:13993003.00541-2019. [PMID: 31391221 PMCID: PMC6860993 DOI: 10.1183/13993003.00541-2019] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/19/2019] [Indexed: 11/09/2022]
Abstract
Background Pleural infection remains an important cause of mortality. This study aimed to investigate worldwide patterns of pre-existing comorbidities and clinical outcomes of patients with pleural infection. Methods Studies reporting on adults with pleural infection between 2000 and 2017 were identified from a search of Embase and MEDLINE. Articles reporting exclusively on tuberculous, fungal or post-pneumonectomy infection were excluded. Two reviewers assessed 20 980 records for eligibility. Results 211 studies met the inclusion criteria. 134 articles (227 898 patients, mean age 52.8 years) reported comorbidity and/or outcome data. The majority of studies were retrospective observational cohorts (n=104, 78%) and the most common region of reporting was East Asia (n=33, 24%) followed by North America (n=27, 20%). 85 articles (50 756 patients) reported comorbidity. The median (interquartile range (IQR)) percentage prevalence of any comorbidity was 72% (58–83%), with respiratory illness (20%, 16–32%) and cardiac illness (19%, 15–27%) most commonly reported. 125 papers (192 298 patients) reported outcome data. The median (IQR) length of stay was 19 days (13–27 days) and median in-hospital or 30-day mortality was 4% (IQR 1–11%). In regions with high-income economies (n=100, 74%) patients were older (mean 56.5 versus 42.5 years, p<0.0001), but there were no significant differences in prevalence of pre-existing comorbidity nor in length of hospital stay or mortality. Conclusion Patients with pleural infection have high levels of comorbidity and long hospital stays. Most reported data are from high-income economy settings. Data from lower-income regions is needed to better understand regional trends and enable optimal resource provision going forward. In pleural infection, patients from higher-income countries tend to be older with more comorbidities and are more likely to be referred for fibrinolytic treatment in comparison to patients from lower-income countrieshttp://bit.ly/2K2M5HL
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Affiliation(s)
- Tamsin N Cargill
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK.,Joint first authors
| | - Maged Hassan
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK .,Joint first authors
| | - John P Corcoran
- Interventional Pulmonology Service, Respiratory Medicine Dept, University Hospitals Plymouth, Plymouth, UK
| | - Elinor Harriss
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Rachelle Asciak
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Rachel M Mercer
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - David J McCracken
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Eihab O Bedawi
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
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8
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Yeung C, Dawson J, Gilbert S. Uniportal video-assisted thoracoscopy approach to the management of non-pulmonary diseases of the chest. J Thorac Dis 2019; 11:S2062-S2068. [PMID: 31637039 DOI: 10.21037/jtd.2019.03.21] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The use of uniportal video-assisted thoracoscopy (u-VATS) is becoming a commonly used surgical technique and can be an effective approach for the surgical treatment of many pulmonary and non-pulmonary conditions. This review article summarizes current medical evidence informing the practice of u-VATS for treating non-pulmonary conditions including hyperhidrosis, hemothorax, pleural effusion, and thymic disease.
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Affiliation(s)
- Ching Yeung
- The Ottawa Hospital Research Institute, University of Ottawa, The Ottawa Hospital - General Campus, Ottawa, ON, Canada.,Faculty of Medicine, Department of Surgery, University of Ottawa, The Ottawa Hospital - General Campus, Ottawa, ON, Canada
| | - Jennifer Dawson
- The Ottawa Hospital Research Institute, University of Ottawa, The Ottawa Hospital - General Campus, Ottawa, ON, Canada
| | - Sebastien Gilbert
- The Ottawa Hospital Research Institute, University of Ottawa, The Ottawa Hospital - General Campus, Ottawa, ON, Canada.,Faculty of Medicine, Department of Surgery, University of Ottawa, The Ottawa Hospital - General Campus, Ottawa, ON, Canada
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9
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Ismail M, Nachira D, Meacci E, Ferretti GM, Swierzy M, Englisch JP, Ossami Saidy RR, Faber S, Congedo MT, Chiappetta M, Petracca Ciavarella L, Margaritora S, Rueckert JC. Uniportal video-assisted thoracic surgery in the treatment of pleural empyema. J Thorac Dis 2018; 10:S3696-S3703. [PMID: 30505554 DOI: 10.21037/jtd.2018.05.10] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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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Affiliation(s)
- Mahmoud Ismail
- Competence Center of Thoracic Surgery, Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dania Nachira
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Elisa Meacci
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Gian Maria Ferretti
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Marc Swierzy
- Competence Center of Thoracic Surgery, Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Julianna Paulina Englisch
- Competence Center of Thoracic Surgery, Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ramin Raul Ossami Saidy
- Competence Center of Thoracic Surgery, Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Svea Faber
- Competence Center of Thoracic Surgery, Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Maria Teresa Congedo
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Marco Chiappetta
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
| | | | - Stefano Margaritora
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Jens C Rueckert
- Competence Center of Thoracic Surgery, Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
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10
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Aljehani Y, Alabkary S. Single incision VATS decortication for 3rd stage empyema. Clin Case Rep 2018; 6:2144-2146. [PMID: 30455908 PMCID: PMC6230628 DOI: 10.1002/ccr3.1743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/20/2018] [Accepted: 07/04/2018] [Indexed: 11/11/2022] Open
Abstract
The use of U-VATS should be preferred to conventional three-port VATS if skills are mastered as it causes less and single intercostal trauma. Moreover, it minimizes infection spread to the chest wall. We advocate the use of U-VATS as a routine approach in patient with empyema stage III for positive outcome.
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Affiliation(s)
- Yasser Aljehani
- Thoracic Surgery DivisionDepartment of SurgeryCollege of MedicineKing Fahad Hospital of the UniversityImam Abdulrahman Bin Faisal UniversityAl‐Khobar, DammamSaudi Arabia
| | - Sukainah Alabkary
- Thoracic Surgery DivisionDepartment of SurgeryCollege of MedicineKing Fahad Hospital of the UniversityImam Abdulrahman Bin Faisal UniversityAl‐Khobar, DammamSaudi Arabia
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