Video-assisted thoracoscopic surgery in the treatment of chronic empyema thoracis.

We prospectively analyzed the surgical results in chronic organizing empyema thoracis utilizing a video-assisted thoracoscopic technique, particularly in debilitated patients. From January 1999 to September 2000, ten patients with stage III empyema thoracis underwent video-assisted thoracoscopic surgery for decortication (VATD). The mean age of the patients was 53.2 years, and they included one female and nine male patients. Four patients were regarded as not suitable for open thoracotomy. After the procedure, all patients had one infusion tube and two 32-F chest tubes inserted, the former for irrigation with saline solution and the latter for drainage. The mean operation time was 178 min. There was no mortality. The mean time to remove the infusion tube was 3.3 days. The mean time to remove the first chest tube was 7.1 days and the second chest tube 9.7 days. The mean hospitalization time after the operation was 14.9 days. The mean follow-up was 14.9 months. A restoration of lung function was ascertained in nine patients, with a 17.6% mean increase in forced vital capacity. There was no recurrence of empyema during the follow-up. Nevertheless, a reaccumulation of pleural effusion occurred in one patient 1 month after the procedure, which thus necessitated further treatment. VATD is considered to be a feasible surgical modality for the treatment of stage III empyema thoracis in selected patients.