Video-assisted thoracic surgery for fibropurulent thoracic empyema: a bridge to open thoracic surgery.
Thoracic empyema remains a serious problem. We evaluated the feasibility and efficacy of video-assisted thoracic surgery (VATS) for fibropurulent thoracic empyema. Twenty-six consecutive patients with thoracic empyema resistant to medical therapy were treated by VATS from 1997 to 2006. The presence of pleural adhesion was not a contraindication. Patients with destroyed lung, bronchopleural fistula, or excessively thickened pleura were excluded. Twenty-two were males and 4 were females with a mean age of 59 years (range 14 to 85). The length of preoperative period was 39.3 +/- 25.3 days, and the length of preoperative treatment was 11.2 +/- 14.3 days. The operating time was 127.6 +/- 45.1 minutes and intraoperative bleeding was 353.8 +/- 438.4 g. Postoperative complications were observed in two cases (8.0%). There were no hospital deaths. Twenty-two cases (84.6%) were cured with a postoperative drainage time of 12.5 +/- 8.2 days. Four cases required an additional operation. However, the VATS procedure was not required to perform additional thoracoplasty using pedicled chest wall muscles. VATS for fibropurulent thoracic empyema is effective and less invasive, and it may be important as a bridge between minimally invasive and conventional open thoracic surgical management.