Thoracotomy versus Video-Assisted Thoracoscopy in Pediatric Empyema (original) (raw)

Is video-assisted thoracoscopic surgical decortication superior to open surgery in the management of adults with primary empyema?

2010

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether videoassisted thoracoscopic surgical decortication (VATSD) might be superior to open decortication (OD) (or chest tube drainage) for the management of adults with primary empyema? Altogether 68 papers were found using the reported search, of which 14 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that VATSD has superior outcomes for the treatment of persistent pleural collections in terms of postoperative morbidity, complications and length of hospital stay, and gives equivalent resolution when compared with OD. One study comparing VATSD and chest tube drainage of fibrinopurulent empyema found video-assisted thoracoscopic surgery (VATS) had higher treatment success (91% vs. 44%; P-0.05), lower chest tube duration (5.8"1.1 vs. 9.8"1.3 days; Ps0.03), and lower number of total hospital days (8.7"0.9 vs. 12.8"1.1 days; Ps0.009). Eight studies comparing early and late empyema report conversion rates to OD of 0-3.5% in early, 7.1-46% in late stage and significant reductions in length of stay with VATSD compared with OD both postoperatively (5 vs. 8 days; Ps0.001) and in total stay (15 vs. 21; Ps0.03). Additionally VATS resulted in reduced postoperative pain (P-0.0001) and complications including atelectasis (Ps0.006), prolonged air-leak (Ps0.0003), sepsis (Ps0.03) and 30-day mortality (Ps0.02). Five studies considered only chronic persistent empyema of which two directly compared VATSD to tube thoracostomy (TT). VATS resolved 88% of cases and had mortality rates of 1.3% compared with 62% and 11%, respectively, for TT. Moreover, conversion to OD was 10.5-17.1% with VATS and 18-37% with TT (P-0.05). In agreement with mixed stage empyema, hospital stay was reduced both postoperatively (8.3 vs. 12.8 days; P-0.05) and in total (14"1 vs. 17"1 days; P-0.05), and when compared with OD (one study), pain (P-0.0001), postoperative air-leak (Ps0.004), hospital stay (Ps0.020) and time to return to work (P-0.0001) were all reduced with VATS. Additionally, re-operation (4.8% vs. 1%; Ps0.09) and mortality (4y123% vs. 0%) were lower in VATS vs. OD.

Is video-assisted thoracoscopic surgical decortication superior to 5 open surgery in the management of adults with primary empyema?

Interactive Cardiovascular and Thoracic Surgery, 2010

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether videoassisted thoracoscopic surgical decortication (VATSD) might be superior to open decortication (OD) (or chest tube drainage) for the management of adults with primary empyema? Altogether 68 papers were found using the reported search, of which 14 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that VATSD has superior outcomes for the treatment of persistent pleural collections in terms of postoperative morbidity, complications and length of hospital stay, and gives equivalent resolution when compared with OD. One study comparing VATSD and chest tube drainage of fibrinopurulent empyema found video-assisted thoracoscopic surgery (VATS) had higher treatment success (91% vs. 44%; P-0.05), lower chest tube duration (5.8"1.1 vs. 9.8"1.3 days; Ps0.03), and lower number of total hospital days (8.7"0.9 vs. 12.8"1.1 days; Ps0.009). Eight studies comparing early and late empyema report conversion rates to OD of 0-3.5% in early, 7.1-46% in late stage and significant reductions in length of stay with VATSD compared with OD both postoperatively (5 vs. 8 days; Ps0.001) and in total stay (15 vs. 21; Ps0.03). Additionally VATS resulted in reduced postoperative pain (P-0.0001) and complications including atelectasis (Ps0.006), prolonged air-leak (Ps0.0003), sepsis (Ps0.03) and 30-day mortality (Ps0.02). Five studies considered only chronic persistent empyema of which two directly compared VATSD to tube thoracostomy (TT). VATS resolved 88% of cases and had mortality rates of 1.3% compared with 62% and 11%, respectively, for TT. Moreover, conversion to OD was 10.5-17.1% with VATS and 18-37% with TT (P-0.05). In agreement with mixed stage empyema, hospital stay was reduced both postoperatively (8.3 vs. 12.8 days; P-0.05) and in total (14"1 vs. 17"1 days; P-0.05), and when compared with OD (one study), pain (P-0.0001), postoperative air-leak (Ps0.004), hospital stay (Ps0.020) and time to return to work (P-0.0001) were all reduced with VATS. Additionally, re-operation (4.8% vs. 1%; Ps0.09) and mortality (4y123% vs. 0%) were lower in VATS vs. OD.

Video Assisted Thoracoscopic Surgery (VATS) Safety and Feasibility in Benign Pathologies

Objectives: Although feasibility and safety of VATS becoming a well-established, many surgeons still consider benign lesions should preferably be approached through an open approach. literature review shows that thoracoscopy have been used since early 40's for benign pathologies so far we still find some centers using the open approach. We aim at evaluation of VATS practice for benign thoracic pathologies with the experience we got through years of knowledge and practice since the first report of VATS uses in benign pathologies Methods: A retrospective study of patients admitted with a clinical diagnosis of benign disease in which VATS therapeutic procedures were done. Results: Two hundred and twenty three patients admitted to the service between March 2009-May 2013. 62.8% (140) were males and 37.2% (83) were females. Ten different categories of benign intrathoracic diseases. The most commonly operated was hyperhydrosis (35.9%) followed by pnemothorax (20.6%). Number of port used were 2 ports in most of the cases (49.8%), 31.8% done using 3 ports and 17.9% used only one port. Mean drainage days were 2.9 days. No chest tube drainage applied in 17% of cases. Complication occurs in 3 cases with no intraoperative mortality. Mean duration of operation were 120.76 minutes. Conclusion: VATS procedures still offer safe and feasible option for treating benign disease with even less duration, hospital stay and ports used compared with historical publications. Effort should be made to encourage more thoracic surgery service to adopt VATS techniques for all benign pathologies.

Surgical Management of Paediatric Empyema: Open Thoracotomy versus Video-assisted Thoracic Surgery

Journal of the College of Physicians and Surgeons Pakistan, 2020

Objective: To compare the effectiveness of open thoracotomy and video assisted thoracic surgery (VATS) for empyema thoracis in paediatric population. Study Design: Observational study. Place and duration of study: This observational study was conducted at Department of Thoracic Surgery, CMH, Lahore, from October 2013 to August 2018. Methodology: Medical record of children up to the age of 14 years who were operated for empyema thoracis was reviewed. Patients were divided into two groups: Open thoracotomy, and VATS; and compared for etiology, preoperative treatment, grade of empyema, procedure performed; histopathology and complications, e.g. post-thoracotomy neuralgia, surgical site infection, recurrence over 6 months. Results: A total of 61 paediatric patients were operated for empyema thoracis. Age ranged between 1 to 14 years (mean = 10.25 ±3.30 years). Most common etiology of empyema was tuberculosis in 24 (39.3%) cases, followed by pneumonia in 22 (36.1%). Surgical treatment consisted of open thoracotomy in 40 (65.5%) cases, while 21 (34.5%) underwent VATS. Postoperative X-ray was satisfactory in 38 (95%) cases undergoing open thoracotomy as compared to 21 (100%) cases undergoing VATS (p=value 0.29). There was no recurrence in either of the two groups over a follow-up period of six months. Overall complication rate was 32.5% (13 cases) in cases undergoing open thoracotomy, while 33.3% (7 cases) in VATS group (p=value 0.95). There was one (2.5%) mortality in open thoracotomy group, while no death occurred in VATS group. Conclusion: Early surgical treatment, both open as well as VATS, gives satisfactory results in management of paediatric empyema. VATS is a safe alternative to open thoractomy with good success rate and less incidence of complications.

Role of Primary Vats for the Treatment of Empyema Thoracis in Children

Acta Scientific Paediatrics, 2022

Introduction: Empyema is an entity frequently encountered in pediatric age group. It is the collection of suppurative fluid in the pleural cavity secondary to bacterial pneumonia and may include other causes such as malignancies and immunological disorders. Different guidelines are available for management of empyema in adults however there is no consensus on management of empyema in children. Generally accepted treatment modalities in the order of minimal to most invasive include Antibiotics, Intercostal Chest Drainage, Fibrinolytic Therapy, Video Assisted Thoracoscopic Surgery (VATS), and open thoracotomy, with open thoracotomy usually being restricted to treating the most advanced stages i.e., stage 3. Material and Methods: This is a retrospective descriptive study conducted at Maternal & Children Hospital; a tertiary care hospital in Nawabshah, Pakistan built with the intention to provide better maternal and child care to the surrounding urban and rural areas. The duration of this study was 6 years (January 2015 to January 2021) during which a total of 65 patients diagnosed with stage II and some stage III empyema were enrolled via non-probability consecutive sampling Results: A total of 65 patients were enrolled during the 6-year period of the study, of which 38 were males and 27 were females, with ages ranging from 2 to 11 years and a median of 6 years. 40 patients (61.5%) underwent primary VATS, whereas the remaining 25 patients (38.5%) underwent secondary VATS (VATS after chest tube for drainage initially). The duration of stay ranged from 3 to 10 days, with a median of 6 and 8 days for Primary and Secondary VATS. Conclusion: Primary VATS is a better modality and, in our experience, should be preferred over simple chest tube drainage where possible. As presented above, the level of complexity is generally lower if opted for earlier. The procedure is simple to learn and will also act in smoothening the learning curve for other thoracoscopic surgeries.

A Prospective Study Comparing Treatment Outcomes Of Empyema Management Techniques: Chest Tube Vs. Video-Assisted Thoracoscopic Surgery

Russian Open Medical Journal, 2022

Introduction-High mortality and morbidity rate of empyema, despite effective antibiotic therapy, highlights the need to determine the optimal drainage method as a first-line surgical intervention. Controversies behind the treatment choice for empyema encouraged us to conduct this study aimed at demonstrating efficacy and differences of two techniques of clinical approach to empyema, chest tube and video-assisted thoracoscopic surgery (VATS) with respect to outcomes. Material and Methods-We recruited 60 eligible patients with empyema and distributed them among two groups according to applied treatment strategies, either chest tube treatment method (Group I, 30 subjects) or VATS (Group II, 30 patients). Data were statistically analyzed by SPSS software, version 19. Then, the one-sample Kolmogorov-Smirnov test confirmed the normality of data distribution, and independent samples t-test was performed. Statistical significance was assumed at p<0.05. Results-We established that the length of hospital stay (p=0.002), the need for second intervention (p<0.001), and rate of recurrence (readmission) (p=0.001) were significantly lower in patients treated with VATS, compared with patients who were subjected to chest tube drainage. Additionally, patients who underwent VATS exhibited higher satisfaction level (p=0.03) and improved clinical condition at the time of discharge (discharged without chest tube) (p<0.001), than those from Group I. Radiographic examination on postoperative day 7 revealed a higher rate of complete cure (normal lung expansion) in the VATS group (p=0.004). Conclusion-According to the results of our study, VATS is a better treatment technique of empyema, compared with chest tube.

Efficacy of video-assisted thoracoscopic surgery in managing childhood empyema: a large single-centre study

Journal of Pediatric Surgery, 2009

Background/Purpose: A randomised controlled trial evaluating the role of video-assisted thoracoscopic surgery (VATS) in childhood empyema reported a failure rate of 16.6%. Our aim is to determine the outcome of VATS in a large series of children managed by 3 paediatric surgeons experienced in endoscopic surgery. Method: A retrospective study of all children with empyema admitted under the care of the 3 surgeons between February 2004 and February 2008 was undertaken. Recorded details included demographic data, mode of presentation, preoperative investigations, operative details, antibiotic usage, microbiological data, postoperative course, follow-up data and complications. Results: 114 children (69 boys, 45 girls) had VATS for empyema. Their median age was 5 (0.2-15) years. The pleural cavity was drained for a median of 4 (2-13) days. Median postoperative hospital stay was 7 (4-36) days. Median follow-up was 8 (1-24) months. There were 8 (7%) treatment failures: 5 conversions to thoracotomy and 3 recurrent empyemas. There were 7 complications (6%): air leak (n = 6) and lung injury (n = 1). 104 (91%) children had full resolution of symptoms. There were no deaths. Conclusion: Video-assisted thoracoscopic surgery has a better outcome in childhood empyema than reported in a recent randomised trial and it has an important role in the management of this condition.

VATS thoracoscopic decortication for empyema thoracic. A retrospective experience and analysis of 162 cases

Journal of the Pakistan Medical Association, 2020

Objective: To analyse the experience of empyema thoracis management using video-assisted thoracoscopic surgery. Method: The retrospective study was conducted at the Combined Military Hospitals, Rawalpindi and Lahore, Pakistan, and comprised data of empyema thoracis cases who underwent thoracoscopic decortications by the same consultant surgeon between January 2009 and 2018. Uniportal or multiportal video-assisted thoracoscopic decortications was done. Histopathology and microbiological sampling were done in all cases. Results: of the 162 cases, 114(70.4%) were done on males and 48(29.6%) on females. The overall mean age was 44±16.37 years. Three ports were utilised in 58(36%) patients. Hospital stay of 122(75.3%) patients was <5 days post-procedure. Post-thoracotomy neuralgia occurred in 19(11.7%) patients, while 9(5.5%) had surgical site infection. Overall complications were 30(18.5%). There was no mortality. Conclusion: Video-assisted thoracoscopic decortications was found to b...

Open thoracic surgery: video-assisted thoracoscopic surgery (VATS) conversion to thoracotomy

Shanghai Chest

Video-assisted thoracoscopic surgery (VATS) approaches are becoming a mainstream technique within the discipline of thoracic surgery. Just as valuable however is to consider when VATS should not be considered, and even more important, when a case that began as VATS should be converted to thoracotomy, and if so, then how. Today the only documented absolute contraindication to VATS is the inability to achieve adequate visualization of the hemithorax. Patients who cannot tolerate single lung ventilation and situations in which lung isolation is not possible typically are not amenable to thoracoscopic approaches. Relative contraindications to VATS include: bronchoplastic procedures, chest wall deformities limiting visualization, large lesions that limit visibility and would ultimately require a large incision and rib spreading for extraction, central/hilar lesions requiring proximal and/or intrapericardial dissection, dense adhesions requiring decortication, calcified hilar adenopathy, neoadjuvant chemotherapy or radiation with challenging dissection, or extensive chest wall involvement. Given the amply available technology, surgeons may often choose to perform an intra-operative VATS exploration prior to thoracotomy. In such a setting, this should not be considered a conversion. Instead we offer the term "adjunctive VATS" to clarify the distinction. Surgeons often begin with a thoracoscopic port placed in the anterior axillary line anywhere in the 8th-9th intercostal space and ultimately utilize that incision as the site for chest tube insertion at the end of the procedure. This is distinctively different from aborting a planned VATS procedure and performing a thoracotomy. Published rates of conversion from VATS to thoracotomy vary. Reasons for conversion can be classified as: intraoperative complications, technical challenges, anatomic problems and oncologic conditions. As important as the technique of conversion, is the ability to make a timely and systematic decision to abort a VATS procedure. Surgeons must be aware that a conversion from VATS to thoracotomy does not represent surgical failure. There are essentially two types of conversions: planned and emergent. Based on the type of conversion, the approach to thoracotomy can differ. Once the decision to convert to VATS is made important principles and technical consideration need to be followed. The core tenant of these is the completion of a safe and oncologically sound operation.