Efficacy Of Medical Thoracoscopy Research Articles

Safety and efficacy of medical thoracoscopy in the management of loculated thoracic empyema

BackgroundPleural empyema can be subdivided into 3 stages: exudative, multiloculated, and organizing. In the absence of clear septation, antibiotics plus simple drainage of pleural fluid is often sufficient treatment, whereas clear septation often requires more invasive treatment. Aim of studyTo evaluate the safety and efficacy of medical thoracoscopy in the management of loculated thoracic empyema. MethodsThis study was conducted at chest department, Al-Azhar Faculty of medicine Al-Housein University Hospital in the period from October 2015 to August 2016. On 30 patients, 22 males and 8 females with age ranging between 20 and 74years (mean age 48.3±15.5years). Diagnosed as loculated thoracic empyema (27 patients) or empyema failed to respond to medical treatment or chest tube drainage (3 patients) were undergo medical thoracoscopy. ResultsA total of 30 patients with loculated empyema were managed by medical thoracoscopy. Histopathological finding of study sample were (Non-specific inflammation 23.3%, Suppurative exudative reaction 16.7%, Tuberculous caseating granuloma 23.3%, Lymphocytic Inflammation 6.7%, fibrino purulent inflammation 13.3%, adenocarcinoma 3.3, Pleural fibrosis and thickening 10% and Pleural calcification, ossification, pleurisy 3.3%). Medical thoracoscopy was considered successful without further intervention in 26 of 30 patients (86.7%), 3 patients (10%) clinically improved but lung did not expanded and referred for thoracic surgery for decortication and 1 patient (3.3%) need for surgery to fistula closure. ConclusionsOur study confirms that loculated pleural empyema could safely and successfully be treated by medical thoracoscopy.

Hippocrates Quoted "If an Empyema Does Not Rupture, Death Will Occur": Is Medical Thoracoscopy Able to Make It Rupture Safely?

The aim of this study was to evaluate the safety and efficacy of medical thoracoscopy through a single port [single-port medical thoracoscopy (S-MT)] for the treatment of empyema thoracis in its early stages. We performed a retrospective analysis reviewing the medical records of 84 patients referred for empyema and treated by medical thoracoscopy at our Thoracic Departments from January 2001 until November 2014. S-MT was performed under local anesthesia with neuroleptoanalgesia and spontaneous breathing using a single 1-cm incision for debridement and lavage of the pleural cavity. A total of 84 patients underwent S-MT for pleural empyema stage I (9 patients, 10.7%) or II (75 patients, 89.3%). Median age was 61.8 years (range, 18 to 84 y). Male to female ratio was 3.76. Surgery was performed 5 to 26 days after the onset of symptoms. Macroscopically complete debridement of the pleural cavity was achieved in 71 patients (84.5% of cases). The rest 15.5% of cases required video-assisted thoracoscopic surgery or open decortication due to trapped-lung syndrome. Median operation time was 45 minutes (range, 30 to 94 min). No intraoperative complications occurred. In-hospital mortality was zero, whereas in-hospital morbidity rate was 16.7%. Median hospital stay was 7.8 days (range, 3 to 18 days). Recurrence rate was 4.8% as 4 patients experienced a relapse of empyema. It seems that S-MT is a minimally invasive, safe and effective procedure for the treatment of pleural empyema with very good results in early stages of the disease and reduced time of hospital stay.

Is Medical Thoracoscopy Efficient in the Management of Multiloculated and Organized Thoracic Empyema?

Background: Pleural empyema can be subdivided into 3 stages: exudative, multiloculated, and organizing. In the absence of clear septation, antibiotics plus simple drainage of pleural fluid is often sufficient treatment, whereas clear septation often requires more invasive treatment. Objectives: The aim of this study was to report our experience and analyze the safety and efficacy of medical thoracoscopy in patients with multiloculated and organizing empyema. Methods: We performed a retrospective study reviewing the files of patients referred for empyema and treated by medical thoracoscopy at our department from July 2005 to February 2011. Results: A total of 41 patients with empyema were treated by medical thoracoscopy; empyema was free flowing in 9 patients (22%), multiloculated in 24 patients (58.5%), and organized in 8 patients (19.5%). Medical thoracoscopy was considered successful without further intervention in 35 of 41 patients (85.4%): all of the 9 patients with free-flowing fluid, 22 of the 24 patients with multiloculated empyema (91.7%), and only 4 of the 8 patients with organizing effusion (50%). Conclusions: Our study confirms that multiloculated pleural empyema could safely and successfully be treated with medical thoracoscopy while organizing empyema can be resistant to drainage with medical thoracoscopy, requiring video-assisted thoracic surgery or open surgical decortications; among this population, the presence of separate ‘pockets’ not in apparent communication with each other often leads to a surgical approach.