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Choi, Choi, Kim, Cho, Ryu, Ahn, and Seo: Results of Application of Video-Assisted Thoracoscopic Surgery for the Treatment of Empyema Thoracis
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2006; 61(5): 463-472.

Published online: 30 November 2006

DOI: https://doi.org/10.4046/trd.2006.61.5.463

Results of Application of Video-Assisted Thoracoscopic Surgery for the Treatment of Empyema Thoracis

Gi Hoon Choi, M.D.1, Goang Min Choi, M.D.2, Hyoung Soo Kim, M.D.2, Seong Joon Cho, M.D.3, Se Min Ryu, M.D.3, Hee Cheol Ahn, M.D.1, Jeong Yeol Seo, M.D.1

1Department of Emergency Medicine, College of Medicine, Hallym University, Korea.

2Department of Thoracic and Cardiovascular Surgery, College of Medicine, Hallym University, Korea.

3Department of Thoracic and Cardiovascular Surgery, College of Medicine, Kangwon National University, Korea.

Address for correspondence: Goang Min Choi, M.D. Department of Thoracic & Cardiovascular Surgery, Chunchon Sacred Heart Hospital, 153, Gyo-dong, Chuncheon-si, Kangwon-do, 200-704 Korea. Phone: 82-33-240-5365 Fax: 82-33-244-0317, gmchoi@hallym.ac.kr

Received 18 September 2006       Accepted 17 October 2006

Copyright © 2006 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Background

Since video-assisted thoracoscopic surgery (VATS) was introduced as a new treatment modality for empyema thoracis, numerous reports have suggested that VATS is a more effective treatment method than the traditional methods that mainly use antibiotics and drainage apparatus. However, no confirmative evidence of the superiority of VATS over the traditional method has been provided yet.

Methods

We attempted to evaluate the efficacy of VATS for the treatment of empyema thoracis by reviewing past medical records and simple chest films. First, we divided the patients into two groups based on the treatment method: group A of 15 patients who were treated with the traditional method between January 2001 and December 2003, and group B of 9 patients who were treated with VATS between December 2003 and August 2006. The final outcomes used in this study were the number of days of hospital stay, chest tube duration, leukocytosis duration, febrile duration, and intravenous antibiotics usage duration. In addition, radiological improvements were compared.

Results

The mean age(±standard deviation) of 11 men and 4 women in group A was 58.2±15.7 years, and of 9 men and 2 women in group B was 51.6±9.5 years. Group B had a significantly shorter hospital stay (16.6±7.4 vs. 33.7±22.6 days; p=0.014), shorter chest tube duration (10.5±5.7 vs. 19.5±14.4 days; p=0.039), shorter leukocytosis duration (6.7±6.5 vs. 18.8±13.2 days; p=0.008), shorter febrile duration (0.8±1.8 vs. 9.4±9.2 days; p=0.004), and shorter duration of intravenous antibiotics usage (14.9±6.4 vs. 25.4±13.9 days; p=0.018). However, radiological improvements did not show any statistical differences.

Conclusion

Early application of VATS for empyema thoracis treatment reduced hospital stay, thoracostomy tube duration, leukocytosis duration, febrile duration, and antibiotics usage duration in comparison with the traditional methods. The early performing of VATS might be an effective treatment modality for empyema thoracis.

Keywords: Empyema thoracis, Pyothorax, Pleural disease, VATS[video-assisted thoracoscopic surgery]

Figures and Tables

Figure 1
The Traditional treatment protocol in Chunchon Sacred Heart Hospital (Group A). The dotted line means the occasion of some complication occuring during observation.
trd-61-463-g001
Figure 2
The present treatment protocol in Chunchon Sacred Heart Hospital (Group B).
The dotted line means a variable way with VATS application in treatment of tuberculotic pleural effusion.
SIRS=Systemic inflammatory response syndrome
trd-61-463-g002
Table 1
Comparison of the traditional treatment group (Group A) and the VATS treated group (Group B)
trd-61-463-i001

*location: right or left pleural cavity where empyema thoracis occurred

†antibiotics day: duration of intravenous antibiotics usage

‡Fisher's exact test, §Chi-square test

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