Level 2 single port local anaesthetic thoracoscopy for empyema – Complications and outcomes

Abstract

INTRODUCTION Video-assisted thoracoscopic surgery (VATS) is indicated in multiloculated empyemas that fail to resolve with antibiotics and chest tube drainage. There is no outcome data for single port local anaesthetic (LA) thoracoscopy in patients unfit for VATS. AIMS To evaluate the complications and outcomes of single port level 2 LA thoracoscopy for the minimally invasive treatment of pleural empyema. METHODS We performed a retrospective case analysis of all patients who underwent LA thoracoscopy at St Thomas9 Hospital, London between March 2013 and December 2015. RESULTS 90 LA thoracoscopies performed, 8 patients underwent single port thoracoscopy, locule debridement and washout for empyema. All patients were unfit for surgical VATS. 7 cases resolved with 1 relapse; caused by a complicated residual pleural space. Inpatient morbidity: 1 post-procedure persistent air leak treated with endobronchial valve; 1 spontaneous intrapleural bleed unrelated to procedure. No in-hospital mortality. Chest tube was removed after a median of 3 days post procedure (range 1-33). Conclusion This is the first case series of level 2 single port LA thoracoscopy for empyema in patients unfit for VATS. Although not routinely used for pleural infection in the UK, our data suggests it is safe with a good outcome in patients in need of a minimally invasive approach. This requires further prospective evaluation.