A retrospective analysis of the video-assisted thoracoscopic surgery performed on 46 patients at a mean age of 49.61 ± 18.96 years with pleural empyema during the period between January 1, 2016 and November 30, 2022 in the Clinic of Thoracic Surgery at the Department of Surgery and in the Department of General and Operative Surgery of the Medical University of Varna was carried out. The patient group consisted of 35 males at a mean age of 48.00 ± 18.88 years and 11 females at a mean age of 54.73 ± 20.25 years. A right or a left stage II pleural empyema without bronchopulmonary fistula was diagnosed in 22 males and in two females, a right or a left stage II pleural empyema stage with fistula—in seven males and in four females, a right or a left stage III pleural empyema without fistula—in five males and in two females, a right or a left stage III pleural empyema with fistula—in one male and in two females, while a stage II bilateral pleural empyema without fistula was found out in one female patient. The video-assisted thoracoscopic surgery was performed along with debridement, decortication, lavage, and drainage in all the patients. The postoperative period was uneventful and the duration of postoperative drainage and hospital stay was short. There were no postoperative complications and perioperative lethality. Based on the very good results obtained from the use of the video-assisted thoracoscopic surgery in pleural empyema patients, a broader application of this contemporary method in Bulgarian practice could be recommended.
Ariyaratnam P, Tcherveniakov P, Milton R, Lodhia J, Chaudhuri N. Video-assisted-thoracoscopic-surgery pleural decorticator for emergency empyema surgery. Surg Innov. 2023 Feb 16:15533506231157170. doi: 10.1177/15533506231157170.
Do H, Nguyen Q, Nguyen L, Nguyen L. Single trocar thoracoscopic surgery for pleural empyema in children. J Laparoendosc Adv Surg Tech A. 2020 Apr 23. doi: 10.1089/lap.2019.0637.
Ershadi R, Vahedi M, Rafieian S. Efficacy of video-assisted thoracoscopic surgery versus intrapleural streptokinase for treatment of parapneumonic empyema with multiloculation and septation. Kardiochir Torakochirurgia Pol. 2022;19(2):86-89.
Garvia V, Paul M. Empyema. In: StatPearls [Internet]. Treasure Island, StatPearls Publishing, 2023.
Ibarra Rodríguez MR, Garrido Pérez JI, Rueda FV, Murcia Pascual FJ, Wiesner Torres SR, Paredes Esteban RM. Fibrinolysis versus thoracoscopy: comparison of results in empyema management in the child. Ann Thorac Med. 2022;17(3):145-150.
Jindal R, Nar AS, Mishra A, Singh RP, Aggarwal A, Bansal N. Video-assisted thoracoscopic surgery versus open thoracotomy in the management of empyema: A comparative study. J Minim Access Surg. 2021;17(4):470-478.
Lin CW, Huang KY, Lin CH, Wang BY, Kor CT, Hou MH, Lin SH. Video-assisted thoracoscopic surgery in community-acquired thoracic empyema: analysis of risk factors for mortality. Surg Infect (Larchmt). 2022;23(2):191-198.
Luciani C, Scacchi A, Vaschetti R, Di Marzo G, Fatica I, Cappuccio M, et al. 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(1):46. doi: 10.1186/s13017-022-00438-8.
Majeed FA, Chatha SS, Zafar U, Ali A, Farhan N, Raza A. VATS thoracoscopic decortication for empyema thoracic: A retrospective experience and analysis of 162 cases. J Pak Med Assoc. 2021;71(2(A)):502-504.
Ohuchi M, Inoue S, Ozaki Y, Fujita T, Ueda K, Kitamura S, et al. Efficacy, safety, and optimal timing of single-trocar video-assisted flexible thoracoscopic debridement under local anesthesia for complicated parapneumonic empyema. Gen Thorac Cardiovasc Surg. 2022;70(7):634-641.
Pilav I, Alihodzic-Pasalic A, Musanovic S, Kadic K, Dapcevic M, Custovic O. Efficacy of ideo-assisted thoracoscopic surgery (VATS) in the treatment of primary pleural empyema. Acta Inform Med. 2020;28(4):261-264.
Pogorelić Z, Bjelanović D, Gudelj R, Jukić M, Petrić J, Furlan D. Video-assisted thoracic surgery in early stage of pediatric pleural empyema improves outcome. Thorac Cardiovasc Surg. 2021;69(5):475-480.
Ricciardi S, Giovanniello D, Carleo F, Di Martino M, Jaus MO, Mantovani S, et al. Which surgery for stage II-III empyema patients? Observational single-center cohort study of 719 consecutive patients. J Clin Med. 2022;12(1):136. doi: 10.3390/jcm12010136.
Semmelmann A, Baar W, Haude H, Moneke I, Loop T. Risk factors for postoperative pulmonary complications leading to increased morbidity and mortality in patients undergoing thoracic surgery for pleural empyema. J Cardiothorac Vasc Anesth. 2023:S1053-0770(23)00252-5. doi: 10.1053/j.jvca.2023.04.017.
Shiroshita A, Kimura Y, Yamada A, Shirakawa C, Yue C, Suzuki H, et al. Prognostic value of computed tomography in empyema: a multicenter retrospective cohort study. Ann Am Thorac Soc. 2023 Jan 23. doi: 10.1513/AnnalsATS.202210-868OC.
Sugiura Y, Nakamura M, Fujimoto H, Ochiai H, Ohkubo Y, Fusegawa H, et al. An independent prognostic factor in surgical cases of pleural empyema caused by common bacteria is the presence of a fistula. Gen Thorac Cardiovasc Surg. 2023 Mar 31. doi: 10.1007/s11748-023-01933-8.
