scholarly journals Operative management of pediatric empyema: a single center review

2018 ◽  
Vol 21 (1) ◽  
pp. 10-13
Author(s):  
Aakriti Sharma ◽  
Ranjan Sapkota ◽  
Bibhusal Thapa ◽  
Prakash Sayami
Keyword(s):  
Thoracoscopic Surgery ◽  
Treatment Options ◽  
Operative Management ◽  
Successful Outcome ◽  
Open Approach ◽  
Empyema Thoracis ◽  
Transplant Center ◽  
Lung Expansion ◽  
Recorded Data ◽  
Video Assisted Thoracoscopic Surgery

Introduction: Empyema thoracis is an uncommon complication of childhood pneumonias but a common problem faced by a thoracic surgeon. Its management is still controversial, with a range of treatment options available and evolving gradually towards adoption of video-assisted thoracoscopic surgery (VATS) as the most commonly practiced one. Aim: The aim of this study was to review our experience in pediatric empyema thoracis. Methods: It was a retrospective review of the prospectively recorded data, spanning a period of 18 months in the Department of Cardio-Thoracic and Vascular Surgery in Manmohan Cardio-Thoracic Vascular and Transplant Center. Results: A total of 40 consecutive patients, 29 males and 11 females, aged 15 years or less were operated upon for a diagnosis of empyema thoracis made based on clinical, radiological and laboratory evidence. All of them were referred patients, mostly from pediatricians. VATS was undertaken in 36 of them, the remaining four treated by open approach. Deloculation sufficed in majority (26/40; 65%) of the patients which mostly (23/26; 90%) had either acute or subacute presentation. Decortication was required in 35% (14/40) of the patients. However, all of the patients but one had a successful outcome in terms of lung expansion, sterilization of the pleural cavity and absence of recurrence. There was no operative mortality. Conclusion: Surgical management of pediatric thoracic empyema is feasible and safe with favorable outcome. VATS is gradually becoming the more favored modality of operative management.  

A six-week inspiratory muscle training and aerobic exercise improves respiratory muscle strength and exercise capacity in lung cancer patients after video-assisted thoracoscopic surgery: A randomized controlled trial

2020 ◽  
pp. 026921552098013
Author(s):  
Jui-Fang Liu ◽  
Nai-Ying Kuo ◽  
Teng-Pei Fang ◽  
Jui-O Chen ◽  
Hung-I Lu ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Aerobic Exercise ◽  
Cancer Patients ◽  
Thoracoscopic Surgery ◽  
Inspiratory Muscle ◽  
Inspiratory Muscle Training ◽  
Muscle Training ◽  
Lung Cancer Patients ◽  
Lung Expansion ◽  
Video Assisted Thoracoscopic Surgery

Objective: To compare the postoperative outcomes of inspiratory muscle training and aerobic exercise, along with standard care, on lung cancer patients undergoing video-assisted thoracoscopic surgery (VATS). Design: A parallel-group, single-blind randomized clinical trial Setting: Thoracic surgery ward and outpatient clinic in a teaching hospital Subjects: Overall 63 patients underwent VATS were randomly assigned to a triaging (TG, n = 32) or control group (CG, n = 31). A total of 54 patients (TG, n = 26; CG, n = 28) completed the study. Intervention: TG: six-week threshold inspiratory muscle training and aerobic exercise. CG: standard care. Main measures: Maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax) lung expansion volume, and 6-min walking test (6MWT) were performed on the day of chest tube removal (baseline), and 2, 6, and 12 weeks postoperatively. Results: The TG showed significant improvement in PImax at week 6 (71.6 ± 34.9 vs. 94.3 ± 32.8 cmH2O, P = 0.018), PEmax at week 2 (70.9 ± 24.3 vs. 90.9 ± 28.2 cmH2O, P = 0.015) and week 12 (76.1 ± 20.2 vs. 98.6 ± 35.3 cmH2O, P = 0.012), the lung expansion volume at week 2 (1080 ± 433 vs 1457 ± 624 mL, P = 0.02) and week 12 (1200 ± 387 vs 1885 ± 678 mL, P < 0.001), in addition to the 6MWT at week 2 (332 ± 78 vs 412 ± 74 m, P = 0.002), week 6 (360 ± 70 vs 419 ± 60 m, P = 0.007) and week 12 (360 ± 58 vs 402 ± 65 m, P = 0.036). Conclusion: A six weeks of inspiratory muscle training and aerobic exercise had improved respiratory muscle strength and aerobic exercise postoperatively in lung cancer patients after VATS as early as 2 weeks.

Readmissions After Lobectomy in an Era of Increasing Minimally Invasive Surgery: A Statewide Analysis

2019 ◽  
Vol 14 (5) ◽  
pp. 453-462
Author(s):  
Brandon S. Hendriksen ◽  
Michael F. Reed ◽  
Matthew D. Taylor ◽  
Christopher S. Hollenbeak
Keyword(s):  
Minimally Invasive ◽  
Surgical Approach ◽  
Health Care Cost ◽  
Thoracoscopic Surgery ◽  
Patient Characteristics ◽  
Open Approach ◽  
Minimally Invasive Surgical ◽  
Chi Squared ◽  
The Impact ◽  
Video Assisted Thoracoscopic Surgery

Objective Utilization of minimally invasive surgical modalities for lobectomy is increasing. Lobectomy can be associated with notable rates of readmission. As use of these modalities increases, evaluation of the impact on readmission is warranted. Methods Data from the Pennsylvania Health Care Cost Containment Council were used to identify lobectomy operations performed in Pennsylvania from 2011 through 2014. Operations were stratified by approach: open, video-assisted thoracoscopic surgery (VATS) or robotic. Differences in patient characteristics were assessed with analysis of variance and chi-squared tests. Logistic regression modeled risk of 30-day readmission and linear regression modeled length of stay (LOS) after controlling for confounders. Results We evaluated 4,939 lobectomy operations (2,501 open, 1,944 VATS, 494 robotic) with 583 readmissions (11.8%). Robotic cases increased 333% over 4 years. VATS and open cases increased 38% and 22%, respectively. Surgical approach was not associated with hospital readmission (VATS odds ratio (OR) = 0.95; P = 0.632; and robotic OR = 1.02; P = 0.916). Longer LOS was associated with a greater likelihood of readmission (OR = 1.58; P = 0.002). LOS was 1 day less for VATS ( P < 0.001) and 1.5 days less for robotic lobectomy ( P < 0.001) when compared to an open approach. The most common reasons for readmission were respiratory complications and nonrespiratory infection. Conclusions Surgical approach does not directly affect readmission. However, minimally invasive lobectomy appears to be associated with shorter LOS and results in more patients discharged home. Decreased LOS and discharge home are associated with fewer readmissions.

scholarly journals Predictors and Clinical Outcomes in Empyema Thoracis Patients Presenting to the Emergency Department Undergoing Video-Assisted Thoracoscopic Surgery

2019 ◽  
Vol 8 (10) ◽  
pp. 1612 ◽  
Author(s):  
Tsai ◽  
Gamper ◽  
Huang ◽  
Lee ◽  
Chang
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Clinical Symptoms ◽  
Thoracoscopic Surgery ◽  
Postoperative Mortality ◽  
Empyema Thoracis ◽  
Video Assisted ◽  
Group I ◽  
Laboratory Examinations ◽  
Video Assisted Thoracoscopic Surgery

Background: Video-assisted thoracoscopic surgery (VATS) is widely used for the treatment of empyema. We evaluated clinical symptoms, laboratory examinations, and thoracentesis to assess patients in the emergency department (ED) with empyema thoracis, undergoing VATS to identify predictors of adverse outcomes. Methods: This retrospective study was conducted by reviewing records of ED patients with pleural empyema admitted for VATS from January 2007 to June 2014. Demographic data, clinical symptoms, and laboratory examinations were compared for survivors (Group I) and non-survivors (Group II). Logistic regression analysis was used to identify parameters related to postoperative mortality. Results: From 380 patients, 7.6% (n = 29) died postoperatively. Survivors and non-survivors exhibited differences in age, gender, presence of cough, dyspnea, chest pain, empyema stage, cerebrovascular disease, malignancy, the glucose level of pleural fluid, serum hemoglobin, platelet count, blood urea nitrogen, and potassium levels. The logistic analysis demonstrated that the most significant factor related to the postoperative morbidity is chest pain (p = 0.018). Conclusions: VATS could be a safe option for pediatric and geriatric patients. Age does not appear to affect postoperative mortality. A high degree of awareness is essential for perioperative management and early surgical treatment when ED patients present with the clinical symptom of chest pain.

Left uniportal VATS for lung decortication after chemical pleurodesis under spontaneous breathing in patient with lymphangiomyomatosis

2021 ◽  
Keyword(s):  
Spontaneous Breathing ◽  
Thoracoscopic Surgery ◽  
Lung Ventilation ◽  
Lung Parenchyma ◽  
One Lung Ventilation ◽  
Chemical Pleurodesis ◽  
Video Assisted ◽  
Lung Expansion ◽  
Talc Poudrage ◽  
Video Assisted Thoracoscopic Surgery

Pneumothorax can be the first symptom of lymphangioleiomyomatosis. Patients with lymphangioleiomyomatosis have a higher risk of recurrence of pneumothorax. Chemical pleurodesis is a viable option to treat the recurrence, but in rare cases, it is not the solution. We present the case of a patient with lymphangioleiomyomatosis undergoing a talc poudrage via video-assisted thoracoscopic surgery for pneumothorax that failed to reexpand the lung. We proposed to the patient a surgical approach to debride the lung parenchyma with the patient under deep sedation with spontaneous breathing. The patient was discharged on the 5th postoperative day. The chest computed tomography scan showed complete lung reexpansion. We advocate that video-assisted thoracoscopic surgery in patients who are awake is a feasible surgical option that permits the restoration of physiological lung expansion in selected patients who underwent chemical pleurodesis and minimizes the risk of one-lung ventilation.

Video-Assisted Thoracoscopic Surgery in the Treatment of Chronic Empyema Thoracis

Surgery Today ◽  
2002 ◽  
Vol 32 (1) ◽  
pp. 19-25 ◽  
Author(s):  
Yu-Jen Cheng ◽  
Hsing-Hsien Wu ◽  
Shah-Hwa Chou ◽  
Eing-Long Kao
Keyword(s):  
Thoracoscopic Surgery ◽  
Empyema Thoracis ◽  
Video Assisted ◽  
Chronic Empyema ◽  
Video Assisted Thoracoscopic Surgery

VATS thoracoscopic decortication for empyema thoracic. A retrospective experience and analysis of 162 cases

2020 ◽  
pp. 1-10
Author(s):  
Farhan Ahmad Majeed ◽  
Sohail Saqib Chatha ◽  
Usama Zafar ◽  
Ahmad Ali ◽  
Nabeela Farhan ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Surgical Site Infection ◽  
Thoracoscopic Surgery ◽  
Site Infection ◽  
Empyema Thoracis ◽  
Efficient Procedure ◽  
Military Hospitals ◽  
Video Assisted ◽  
Post Procedure ◽  
Video Assisted Thoracoscopic Surgery

Abstract Objective: To analyse the experience of empyema thoracis management using video-assisted thoracoscopic surgery. Method: The retrospective study was conducted at the Combined Military Hospitals, Rawalpindi and Lahore, Pakistan, and comprised data of empyema thoracis cases who underwent thoracoscopic decortications by the same consultant surgeon between January 2009 and 2018. Uniportal or multiportal video-assisted thoracoscopic decortications was done. Histopathology and microbiological sampling were done in all cases. Results: of the 162 cases, 114(70.4%) were done on males and 48(29.6%) on females. The overall mean age was 44±16.37 years. Three ports were utilised in 58(36%) patients. Hospital stay of 122(75.3%) patients was <5 days post-procedure. Post-thoracotomy neuralgia occurred in 19(11.7%) patients, while 9(5.5%) had surgical site infection. Overall complications were 30(18.5%). There was no mortality. Conclusion: Video-assisted thoracoscopic decortications was found to be a safe, effective and efficient procedure. Key Words: VATS, Decortication, Empyema thoracis. Continuous...

scholarly journals Ultrasonography in the diagnosis of lung adhesion before surgery

2019 ◽  
Vol 10 (1) ◽  
pp. 128-132
Author(s):  
Mohsen Eshraghi ◽  
Ahmad Kachoie ◽  
Soroush Sharifimoghadam
Keyword(s):  
Negative Predictive Value ◽  
Predictive Value ◽  
Thoracoscopic Surgery ◽  
Thoracic Wall ◽  
Open Approach ◽  
Chest Ultrasonography ◽  
Visceral Injury ◽  
Video Assisted ◽  
Trocar Placement ◽  
Video Assisted Thoracoscopic Surgery

AbstractBackgroundThe presence of pleural adhesions may render video-assisted thoracoscopic surgery difficult or impossible. The aim of this study was to assess the value of chest ultrasonography in the detection of pleural adhesions prior to thoracotomy.MethodsBetween 2013 and 2014, 42 consecutive patients undergoing thoracotomies (including video-assisted thoracicsurgery) were evaluated with chest ultrasonography. These patients underwent a preoperative ultrasonic examination of the chestwall using a 7.5-10-MHz linear ultrasound probe at 7 points along the chest wall. We measured the movement of the visceral pleuralslide.ResultsIn the upper thoracic wall,ultrasonography demonstrated a sensitivity of 63.0%, a specificity of 66%, a negative predictive value of 77%, a positive predictive evalue of 50.0%, and an overall accuracy of 65.0%. And for the lower thoracic wall, ultrasonography demonstrated a sensitivity of 81.0%, a specificity of 59.0%,a negative predictive value of 89.0%, a positive predictivevalue of 44.0%, and an overall accuracy of 65.0%.ConclusionChest ultrasonography is moderately accurate in detecting the presence and location of pleural adhesions. The use of preoperative chest sonographic findings to plan trocar placement and to determine the need for an open approach is valuable in helping prevent visceral injury and facilitating video-assisted thoracoscopic surgery.

Hydrothorax: Pleural Effusion Associated with Peritoneal Dialysis

2010 ◽  
Vol 30 (1) ◽  
pp. 13-18 ◽  
Author(s):  
Susie Q. Lew
Keyword(s):  
Peritoneal Dialysis ◽  
Surgical Intervention ◽  
Thoracoscopic Surgery ◽  
Treatment Options ◽  
Medical Attention ◽  
Imaging Studies ◽  
Ultrafiltration Rate ◽  
Diagnostic Dilemma ◽  
Dialysis Adequacy ◽  
Video Assisted Thoracoscopic Surgery

Hydrothorax in a patient treated with peritoneal dialysis (PD) poses a diagnostic dilemma. Hydrothorax due to migration of dialysis fluid across the diaphragm and into the pleural space creates a serious complication of PD but generally does not threaten life. Shortness of breath causes the patient to seek medical attention. A sudden diminution in dialysis adequacy or poor ultrafiltration rate constitutes a unique marker for patients treated with PD compared to the general population. This article reviews the etiology for hydrothorax specifically in the PD population. Thoracentesis with chemical analysis of the fluid, imaging studies with and without contrast or markers, and video-assisted thoracoscopic surgery play important roles in the evaluation of hydrothorax. A conservative PD regimen, surgical intervention, and pleurodesis provide treatment options to those receiving PD.

scholarly journals Uniportal thoracoscopic surgery for difficult late stage empyema: Case series

2021 ◽  
Vol 2021 (1) ◽  
Author(s):  
Klein Dantis
Keyword(s):  
Methicillin Resistant Staphylococcus Aureus ◽  
Thoracoscopic Surgery ◽  
Case Series ◽  
Open Approach ◽  
Open Thoracotomy ◽  
Invasive Approach ◽  
Video Assisted ◽  
Chronic Empyema ◽  
Clinical Scenarios ◽  
Video Assisted Thoracoscopic Surgery

Early, aggressive, and minimally invasive approach is an advanced surgical approach for chronic empyema management. The traditional video-assisted technique is considered superior over open thoracotomy for empyema management; however, with further modification, the uniportal video-assisted thoracoscopic surgery (UVATS) has greater advantage for surgeons, providing better anatomical view of target tissues, allowing bimanual instrumentation similar to open approach, and nullifying the creation of dihedral angle by instruments that are not favorable in traditional VATS. The present case series describes different clinical scenarios including chronic empyema secondary to traumatic hemothorax, recurrent tubercular empyema following postoperative open decortication, and methicillin-resistant staphylococcus aureus chronic empyema in pediatric patient, which are effectively managed with UVATS approach.

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