title: Balloon-assisted single-port thoracoscopic debridement in children with thoracic empyema.
abstract: OBJECTIVE
  In this study, we evaluated the results of a balloon-aided single-port thoracoscopic debridement of late-stage thoracic empyema in children.
  
  
  METHODS
  We retrospectively reviewed age, gender, duration of prehospital illness, physical findings, surgical interventions, and the morbidity in 12 children with late-stage parapneumonic empyema. The diagnosis of pleural effusion was confirmed by a thoracocentesis before thoracoscopy. A balloon connected to a 12 F feeding tube was inserted into the thoracic cavity and inflated with air before the enterance of the thoracoscope. By this maneuver, a cavity was formed just under the enterance point. Thereafter, a routine debridement and chest irrigation was performed by thoracoscopy. Only one port was inserted in all but 1 patient, and the telescope was used as a dissecting tool. A thorax tube was inserted through the port site at the end of the procedure and left for the drainage.
  
  
  RESULTS
  The main symptoms of the patients were dyspnea, cough, and fever. The empyema was located on the right hemithorax in 5 patients and on the left side in 7 patients. A second port was necessary to enhance the dissection in 1 case. The chest tube was removed within 3-30 days (median, 11 days) after the surgical approach. No complication directly related to the procedure was seen. The only problems postoperatively were a self-limited and spontaneously resolved bronchopleural fistula in 4 patients, and we had to perform an additional thoracoscopy to resolve the remaining intrapleural adhesions in 1 child.
  
  
  CONCLUSIONS
  Thoracoscopic debridement in patients with late-stage thoracic empyema may be very beneficial, and this treatment method may provide any further thoracotomy. A balloon inflated in the thoracic cavity may achieve a wider field of vision for thorascopic surgery, and single-port thoracoscopy is sufficient and safe for the dissection.
authors: Department of Pediatric Surgery, Ondokuz Mayis University, Samsun, Turkey. btander@omu.edu.tr
authors: Burak
authors: B
authors: Tander
authors: Levent
authors: L
authors: Ustun
authors: Ender
authors: E
authors: Ariturk
authors: Riza
authors: R
authors: Rizalar
authors: Suat H
authors: SH
authors: Ayyildiz
authors: Ferit
authors: F
authors: Bernay
mesh_terms: D000293:Adolescent; D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D003646:Debridement / Q000379:methods*; D016724:Empyema, Pleural / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D007507:Therapeutic Irrigation; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*