Management of Pleural Empyema Using VATS with Jet-Lavage System

Abstract

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.