Management of Pleural Empyema Using VATS with Jet-Lavage System
Journal of Surgery
Volume 6, Issue 5, October 2018, Pages: 135-139
Received: Jul. 23, 2018;
Accepted: Sep. 21, 2018;
Published: Oct. 25, 2018
Views 913 Downloads 84
Eduard Kusch, Department of General, Visceral and Thoracic Surgery, Sankt Elisabeth Hospital, Guetersloh, Germany
Follow on us
Pleural empyema is a serious medical condition that is treated according to the stage. Because of the protracted course of this disease, treatment is very problematic in many cases. In general, pleural empyema therapy should be early and stage-appropriate. In stage I a combination of antibiotic therapy and drainage of the infected pleural effusion via a chest tube is performed. In stage II, proper drainage of loculated pleural empyema is only possible with operative intervention (Video-assisted thoracoscopy). The III stage of the disease results in pleural thickening which hinders lung expansion and restricts pulmonary function significantly. Therefore, early thoracotomy within 3 to 4 weeks is advised to prevent the formation of pleural thickening. In this study, pleural empyema in stage II is treated by means of video-assisted thoracoscopy with jet lavage The purpose of video-assisted thoracoscopy is the resolution of septations and removal of fibrin patches to allow the re-expansion of the lung. The Pulsavac Plus system is highly efficient through a variety of attachments coupled with a high flushing performance. In general, 3 accesses are required: 1 x 10 mm trocar for the camera, 1 x 15 mm trocar for the Pulsavac Plus system and 1 x 5 mm trocar for additional instruments. Between 1998 and 2015, a total of 311 patients were treated successfully with the above technique. Pulsed lavage irrigation provided efficient debridement by most patients and can, therefore, be considered as a useful alternative to the already established procedures. 90% of patients (279/311) were successfully treated. In this paper, a not yet established surgical technique is presented (Video-assisted thoracoscopy with jet lavage), which offers an alternative to the conventional surgical techniques. The results are promising. The median hospital stay averaged 8 days. Randomized trials are still, of course, necessary to evaluate the effectiveness of the procedure.
Pleural Empyema, Video Assisted Thoracoscopy, Jet-Lavage-Debridement
To cite this article
Management of Pleural Empyema Using VATS with Jet-Lavage System, Journal of Surgery.
Vol. 6, No. 5,
2018, pp. 135-139.
Copyright © 2018 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/
) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Heffner JE, Brown LK, Barbieri C, DeLeo JM. Pleural fluid chemical analysis in parapneumonic effusions. A meta-analysis.Am J RespirCrit Care Med 1995; 151: 1700-1708.
Nakamura H, Taniguchi Y, Miwa K, Adachi Y, Fujioka S, Haruki T. Surgical outcome of video-assisted thoracic surgery for acute thoracic empyema using pulsed lavage irrigation, Gen Thorac Cardiovasc Surg 2010; 58: 126-130.
Maskell NA, Davies CW, Jones E. The characteristics of 300 patients participating in the MRC/BTS multicentre intra-pleural streptokinase vs. placebo trial. Presented at the American Thoracic Society Meeting, Atlanta (GA); 2002.
Maskell NA, Davies RJO. Effusions from parapneumonic infection and empyema. In: Light RW, Lee YCG, editors. Textbook of pleural diseases. London: Arnold; 2003. pp. 310-328.
Klopp M,Pfannschmidt J,Dienemann H. Behandlung des Pleuraempyems. Chirurg 2008.
Kolditz M, Höffken G. Management des parapneumonischen Ergusses und des Pleuraempyems. Pneumologe 2008.
Lesser T. Minimal-invasive Thoraxchirurgie. Pneumologe 2008.
Hamm H. Pleuraerguss: Rationale Diagnostik und Therapie. Pneumologe 2007.
Solaini L, Prusciano F, Bagioni P. Video-assisted thoracic surgery in the treatment of pleuralempyema. SurgEndosc 2007; 21:280-284.
Kern L, Brutsche MH.Behandlung des Pleuraempyems mittels internistischer Thorakoskopie.Pneumologe 2010.
Busk H, Huth C, Schreiber J.Chirurgie bei nichtonkologischen entzündlichen Thoraxerkrankungen. Pneumologe 2010.
Luh SP, Hsu GJ, Cheng-Ren C. Complicated parapneumonic effusion and empyema: pleural decortication and video-assisted thoracic surgery. Curr Infect Dis Rep 2008; 10:236-240.
TasciS, Ewig S, Lüderitz B. Diagnose und Therapie von parapneumonischen Pleuraergüssen und Empyemen. Dtsch Arztebl 2004; 101: A-638 / B-532 / C-521.
Bergmann T, Bölükbas S, Beqiri S, Schirren J. Diagnostische videoassistierte Thorakoskopie. Chirurg 2006.
Tasci S et al. Langzeitergebnisse der intrapleuralen Fibrinolytikatherapie komplizierter parapneumonischer Pleuraergüsse und Empyeme über kleinlumige Katheter. Medizinische Klinik 2005; Volume 100: pp 181-185.
Rahman NM, Maskell NA, West A et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med. 2011; 365: 518-526.