Abstract
Purpose: The effectiveness of video-assisted thoracic surgery (VATS), even uniportal VATS (U-VATS), in the treatment of pleural empyema has recently been demonstrated. However, few works have evaluated its safety and feasibility for children. We review our experience with U-VATS in the treatment of pleural empyema for children under 11 years old.Methods: From January 2019 to December 2020, we consecutively enrolled 21 children with stage II and stage III pleural empyema in our institution. A 1.0 cm utility port was created in the 5th intercostal space at the anterior axillary line. A rigid 30°5 mm optic thoracoscope was used for vision, and two or three instruments were used through the port. Surgery was based on three therapeutic columns: removal of pleural fluid, debridement, and decortication. A chest tube was inserted through the same skin incision. Perioperative data and outcomes were summarized.Results: The procedures were successful, and satisfactory debridement of the pleural cavity was achieved in all cases. The mean age was 4.1 years (range: 6 months to 11 years old). The mean operating time was 65.7 ± 23.2 min. No intraoperative conversion or major complications were identified among the patients. The mean hospital stay was 5.0 ± 0.6 days. At a follow-up of more than 4 months after operating, all patients had recovered well without recurrence.Conclusion: According to our experience, U-VATS debridement is feasible for the surgical management of stage II and III empyema in the pediatric population. Indeed, U-VATS permits easier performance and complete debridement and decortication, with a very low risk for conversion.
Highlights
Pleural empyema is defined as the presence of purulent fluid in the pleural cavity
We report our experience with UVATS in the treatment of pleural empyema in children
All patients were treated with broad-spectrum antibiotic therapy
Summary
Pleural empyema is defined as the presence of purulent fluid in the pleural cavity. It is due to pleural space infection resulting from post-bacterial pneumonia in the majority of cases [1]. According to its radiological (X-ray, computed tomography scan, and ultrasonography) features, empyema is classified into three stages [2]: Stage I: Parapneumonic effusion, with an increase in pleural effusion; Stage II: Fibrinopurulent stage with loculations of pleural fluid and fibrinous septa formation; Stage III: Chronic organizing stage with scar adhesions and progressive constriction resulting in incarcerated lung. For pleural empyema in children: A systematic review of 44 retrospective studies comparing different treatment strategies [4]. They were chest tube therapy (16 studies, 611 cases), chest tube with fibrinolytic drug (10 studies, 83 cases), video-assisted thoracic surgery (VATS) (22 studies, 449 cases) and thoracotomy (13 studies, 226 cases). The American Association for Thoracic Surgery (AATS) recommends VATS debridement rather than open thoracotomy for the surgical management of empyema in the pediatric population [5]
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