title: Uniportal thoracoscopic decortication for pleural empyema and the role of ultrasonographic preoperative staging.
abstract: The surgical approach to chronic pleural empyema is still controversial. Video-assisted thoracic surgery (VATS) debridement and decortication has shown favourable outcomes, while the uniportal VATS (U-VATS) approach is still anecdotal. We report our experience with ultrasonographic (US) preoperative staging followed by U-VATS decortication for pleural empyema.
  
  
  
  We performed a retrospective analysis of patients who underwent surgical treatment of stage II and stage III pleural empyema from 2012 to 2015. Pre-, intra- and postoperative data were investigated to evaluate outcomes including postoperative complications and disease recurrence. Results were analysed according to preoperative US appearance of pleural space (stages A-E) and surgical approach (thoracotomy vs U-VATS).
  
  
  
  We performed 30 (47%) uniportal thoracoscopic pleural decortication and 34 (53%) open decortication for empyema in stage II (40%) or III (60%) obtaining a complete debridement and decortication in all patients. In-hospital mortality was zero and overall morbidity was 29%. U-VATS was associated with lower blood loss (118 ±  80 ml vs 247  ±  140 ml P  < 0.001), lower chest tubes duration (5.6 ±  1.4 vs 10.6  ±  4.4 days P  < 0.001), shorter hospital stay (6.7  ±  1.9 vs 12.2  ± 4.7 days, P  < 0.001) and lower complications (10% vs 16%, P  < 0.001). Elevated US patterns (D-E) are associated with thoracotomy, higher blood loss, operative time and a significant incidence of complications.
  
  
  
  Uniportal thoracoscopic decortication for pleural empyema is a safe and effective approach for selected patients based on a combination of clinical and imaging staging. US patterns well corresponded with intraoperative pleural findings and showed a prognostic value.
authors.affiliation: Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bongiolatti
authors.affiliation: Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Voltolini
authors.affiliation: Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Borgianni
authors.affiliation: Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Borrelli
authors.affiliation: Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Tancredi
authors.affiliation: Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Viggiano
authors.affiliation: Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gonfiotti
mesh_terms: D000328:Adult; D000368:Aged; D015505:Chest Tubes; D003646:Debridement; D016724:Empyema, Pleural / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy; D014463:Ultrasonography
keywords: Decortication; Pleural empyema; Ultrasonography; Uniportal-VATS surgery