title: Hippocrates Quoted "If an Empyema Does Not Rupture, Death Will Occur": Is Medical Thoracoscopy Able to Make It Rupture Safely?
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Departments of *Thoracic Surgery ‡General Surgery, General Oncology Hospital of Kifissia "Agioi Anargyroi", Kifissia, Athens, Greece Departments of †Respiratory Medicine §Thoracic Surgery, King's College Hospital, London ∥Department of Thoracic Surgery, Nottingham University Hospital, Nottingham, UK.
authors.forename: Georgia
authors.initials: G
authors.lastname: Hardavella
authors.forename: Nikolaos A
authors.initials: NA
authors.lastname: Papakonstantinou
authors.forename: Ioannis
authors.initials: I
authors.lastname: Karampinis
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Papavasileiou
authors.forename: Shereen
authors.initials: S
authors.lastname: Ajab
authors.forename: Mohammed
authors.initials: M
authors.lastname: Shafaat
authors.forename: Stavros
authors.initials: S
authors.lastname: Malagaris
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Anastasiou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003646:Debridement / Q000379:methods*; D016724:Empyema, Pleural / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000009:adverse effects*; D016896:Treatment Outcome; D055815:Young Adult