Efficacy, safety, and optimal timing of single-trocar video-assisted flexible thoracoscopic debridement under local anesthesia for complicated parapneumonic empyema

• Published in: General thoracic and cardiovascular surgery Vol. 70; no. 7; pp. 634 - 641
• Main Authors: Ohuchi, Masatsugu, Inoue, Shuhei, Ozaki, Yoshitomo, Fujita, Takuya, Ueda, Keiko, Kitamura, Shoji, Namura, Yuki
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01.07.2022; Springer Nature B.V
• Subjects: Antibiotics; Cardiac Surgery; Cardiology; Debridement; Fistula; Hospitals; Infections; Local anesthesia; Medical diagnosis; Medical records; Medicine; Medicine & Public Health; Original Article; Ostomy; Patients; Pleural effusion; Sepsis; Surgical Oncology; Thoracic Surgery; Tomography; Ultrasonic imaging; Variables; Empyema; Pleural infection; Video-assisted thoracoscopic surgery; Thoracoscopy; Local anesthesia
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-022-01780-z

Objective Thoracoscopic debridement under local anesthesia is a useful approach for complicated parapneumonic effusion or empyema (CPE) and is a less invasive procedure than video-assisted thoracoscopic surgery under general anesthesia. There are various methods of thoracoscopic debridement under local anesthesia, although the optimal timing of treatment is unknown. The objective of this study was to verify the efficacy and safety of our video-assisted flexible thoracoscopic debridement (VAFTS-D) procedure under local anesthesia, and to investigate the clinical features associated with the success of VAFTS-D. Methods The study included 71 consecutive patients with CPE who underwent VAFTS-D. The primary outcome was success of VAFTS-D. We retrospectively analyzed the efficacy and safety of VAFTS-D from the clinical data obtained from hospital medical records, and used univariate logistic analyses to identify potential predictors of the outcome. Results VAFTS-D was considered successful in 62 of 71 patients (87.3%). Two of the remaining nine patients died and the other seven patients required subsequent operation under general anesthesia. Complications due to VAFTS-D occurred in six patients (8.5%). Duration of empyema < 10 days ( P  = 0.024) and negative bacterial culture in pleural effusion ( P  = 0.029) were independently associated with the success of VAFTS-D by univariate logistic regression analysis. Conclusion VAFTS-D might be an acceptable first-line procedure in patients with suspected CPE. VAFTS-D should be performed as early as possible for a successful outcome, and to obtain useful information on the pleural cavity.