title: Diagnostic and therapeutic performance of video-assisted thoracoscopic surgery (VATS) in investigation and management of pleural exudates.
abstract: BACKGROUND
  Video-assisted thoracoscopic surgery (VATS) is the gold standard investigation for diagnosis of pleural exudates. It is invasive and it is important to ensure that it is performed to acceptable national standards. We assumed that VATS empyema fluid culture would not contribute further to microbiological diagnosis in referred culture-negative empyemas.
  
  
  METHODS
  Eighty-six consecutive external referrals for VATS for diagnosis of a cytology-negative pleural exudate (or for further management of the exudate) were studied retrospectively. Diagnostic yield, pleurodesis efficacy and complications were compared to national standards and good practice recommendations. VATS empyema fluid microbiological culture results were compared to pre-VATS empyema fluid culture results.
  
  
  RESULTS
  VATS was performed well within national standards with a diagnostic yield of 82.3% for cytology-negative exudates, 100% pleurodesis efficacy, 5.8% postoperative fever, with only one significant complication (1.2% rate) and no deaths. Compliance with good practice pleural fluid documentation points was greater than 70%. VATS empyema fluid culture positivity (84.6%) was significantly higher than pre-VATS fluid culture (35%).
  
  
  CONCLUSIONS
  VATS was performed to acceptable standards. These data confirm the utility and safety of VATS in the right context but also suggest the potential diagnostic utility of VATS empyema fluid culture. Further studies are required to investigate this latter possibility further.
authors.affiliation: Department of Cardiothoracic Surgery, Derriford Hospital, Plymouth, UK. andrewmedford@hotmail.com
authors.forename: A R L
authors.initials: AR
authors.lastname: Medford
authors.forename: Y M
authors.initials: YM
authors.lastname: Awan
authors.forename: A
authors.initials: A
authors.lastname: Marchbank
authors.forename: J
authors.initials: J
authors.lastname: Rahamim
authors.forename: J
authors.initials: J
authors.lastname: Unsworth-White
authors.forename: P J K
authors.initials: PJ
authors.lastname: Pearson
mesh_terms: D005122:Exudates and Transudates / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D010996:Pleural Effusion / Q000382:microbiology / Q000601:surgery*; D012017:Referral and Consultation; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted