Current Thoracic Surgery 2022 , Vol 7 , Issue 2
Minimally invasive approach to pleural empyema: uniportal or biportal?
Kerim Tuluce1,Hasan Turut1
1Department Thoracic Surgery, Recep Tayyip Erdogan University, Training and Research, Rize, Turkey DOI : 10.26663/cts.2022.010 Viewed : 342 - Downloaded : 160 Background: Video-assisted thoracoscopic surgery (VATS) has become the standard treatment method for pleural empyema’s surgical treatment. Postoperative pain, length of hospital stay, and cosmetic results are satisfactory, especially with the uniportal approach. In this study, we retrospectively evaluated and compared outcomes of patients treated with uniportal and biportal VATS.

Materials and Methods: A total of 73 patients who underwent VATS for empyema in our clinic between January 2017 and October 2020 were retrospectively evaluated. Patients who underwent uniportal and biportal VATS were compared in terms of age, sex, side and stage of empyema, length of hospital stay, comorbidities, smoking history, American Society of Anesthesiologists (ASA) physical status score, number of chest tubes placed postoperatively, postoperative Heimlich valve placement, postoperative complications, postoperative drainage volume, recurrence, preoperative and 72-h postoperative C-reactive protein (CRP) and white blood cell (WBC) values, and postoperative 24-h and 72-h VAS (visual analog scale) pain scores. Univariate comparisons were done with R-based Jamovi statistical software.

Results: Fifty-two (71.2%) of the patients were male, and the mean age was 57 (IQR 41-67). Empyema was stage 2 in 38 (52.1%) patients and stage 3 in 35 (47.9%) patients. VATS was uniportal in 52 patients (71.2%) and biportal in 21 patients (28.8%). The uniportal VATS group had significantly lower drainage volume (p = 0.006) and VAS scores (p < 0.001). There were no statistical differences in the other parameters.

Conclusions: Our data indicate that uniportal VATS was superior to biportal VATS for the treatment of empyema in terms of postoperative pain and drainage. Keywords : minimally invasive surgery, thoracoscopy, video-assisted thoracoscopic surgery, empyema