1. Results 2
Level 2 Single Port Local Anaesthetic Thoracoscopy for Empyema – Complications and Outcomes
Parthipan Sivakumar1, Farinaz Noorzad1, Liju Ahmed1
1Guys’ and St Thomas’ NHS Foundation Trust, London
Introduction
Video-assisted thoracoscopic surgery (VATS) is indicated in multiloculated empyemas that fail to resolve with antibiotics and tube thoracostomy drainage. Data on empyema outcomes following local anaesthetic (LA) thoracoscopy is limited. Although a retrospective series has demonstrated safety and effectiveness of LA thoracoscopy in stage 2 disease, patients with ultrasound-stratified stage 3 disease were referred for surgical VATS / thoracotomy.1  There is no outcome data for single-port LA thoracoscopy in stage 3 empyema deemed unfit for VATS. 1
Results
Of 90 LA thoracoscopies performed, 8 patients underwent single port thoracoscopy, locule debridement and washout for empyema. All patients had stage III disease and were deemed unfit for surgical VATS.
Inpatient morbidity
1 post-procedure persistent air leak treated with endobronchial valve
1 spontaneous intrapleural bleed unrelated to procedure.
No occurrences of in-hospital mortality. Chest tube was removed after a median of 3 days post procedure (range 1-33). 4 5
Figure 1: Thoracoscopic views: a) multiple loculations and septations seen in stage 2 empyema. b) tethering of lung to chest wall being released using closed biopsy forceps. c & d) visceral pleural fibrosis with pus following empyema evacuation and locule debridement seen in stage 3 disease
Aim
To evaluate the complications and outcomes of single port level 2 LA thoracoscopy for the minimally invasive treatment of pleural empyema. 2
Age (mean)
66.1yrs (SD 14.39)
Male : Female
7:1
Immunocompromised
Immunocompetent 4
Empyema diagnosis
Microbiological
Histological
2 (strep milleri, bacteroides) 6
Stage
III 8
Inpatient morbidity
Persistent air leak
Intrapleural bleed (unrelated) 1
Inpatient mortality
Resolution
Relapse 7
Discussion
Performing LA thoracoscopy for empyema requires ultrasound stratification, consideration of adjunctive fibrinolysis and liason with thoracic surgical colleagues. We demonstrate in selected cases it is safe and effective in the management of patients with evidence of stage 3 empyema who are deemed unfit to undergo surgery.
Further prospective evaluation and long term outcome data is required. 6
Methods
We performed a retrospective case analysis of all patients who underwent LA thoracoscopy for empyema at St Thomas' Hospital, London between March 2013 and December 2015.
The primary end point is complications and morbidity directly arising from level 2 LA thoracoscopy for empyema. Secondary end points include treatment success, inpatient mortality and relapse. 3
Conclusion
Although not routinely used for pleural infection in the UK, our data suggests LA thoracoscopy is safe with a good outcome in patients in need of a minimally invasive approach. 7
Table 1: Demographics, outcomes and complications in the patient group
References
Brutsche MH, Tassi GF, Gyorik S, et al. Treatment of sonographically stratified multiloculated thoracic empyema by medical thoracoscopy. Chest. 2005;128(5):