Surgical outcome of video-assisted thoracic surgery for acute thoracic empyema using pulsed lavage irrigation.
OBJECTIVE
The essential points of video-assisted thoracic surgery (VATS) for acute thoracic empyema are the decortication of thickened pleura, resection of necrotic tissues and fibrin blocks, and drainage. Pulsed lavage irrigation, which is commonly used in orthopedic surgery as a method of sufficiently performing the technique, was used under a thoracoscope to study the efficacy of the treatment for acute thoracic empyema.


METHODS
The subjects comprised 31 patients who had undergone VATS for acute thoracic empyema. There were 26 men and 5 women with an average age of 60.5 years. For the surgical technique, the thickened pus-producing pleura were decorticated under a thoracoscope. The pulsed lavage irrigation system was used after the intrathoracic space had become a single cavity. Using the tip for an intraspinal space, lavage and suctioning were repeated with 5-10 l of a pressurized warm saline solution.


RESULTS
Fibrin blocks and necrotic tissues were easily removed by spray washing with pressurized fluid. The operating time was 150.8 min; the amount of bleeding, including suctioned pleural effusion, was 478.5 g; and the postoperative duration of drainage was 10.7 days. During the postoperative course, the addition of open window thoracotomy due to the relapse of empyema due to methicillin-resistant Staphylococcus aureus was observed in only one patient (3.2%). All of the other patients improved despite their concomitant diseases.


CONCLUSIONS
The use of pulsed lavage irrigation under a thoracoscope for acute thoracic empyema provides simple, efficient débridement or drainage.
Nakamura
Hiroshige
H
Division of General Thoracic Surgery, Tottori University Hospital, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan. hnaka@med.tottori-u.ac.jp
Taniguchi
Yuji
Y
Miwa
Ken
K
Adachi
Yoshin
Y
Fujioka
Shinji
S
Haruki
Tomohiro
T
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003646:Debridement; D016724:Empyema, Pleural / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013396:Suction; D007507:Therapeutic Irrigation / Q000009:adverse effects / Q000295:instrumentation; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome