The Experts below are selected from a list of 321 Experts worldwide ranked by ideXlab platform
Paolo Bagioni - One of the best experts on this subject based on the ideXlab platform.
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video assisted thoracic surgery in the treatment of Pleural Empyema
Surgical Endoscopy and Other Interventional Techniques, 2007Co-Authors: Luciano Solaini, F. Prusciano, Paolo BagioniAbstract:The use of video-assisted thoracic surgery (VATS) in the treatment of Pleural Empyema has been proposed since the early 1990s, but among surgeons, its use varies considerably, and the results are discordant. This report aims to provide a retrospective assessment of the authors’ experience and the literature on VATS in an effort to ascertain rational criteria for the use of this technique. Over a period of 12 years, a total of 120 cases of Pleural Empyema were recorded. The patients were assessed with chest x-ray, computed tomography, ultrasound, and thoracentesis. On the basis of clearly defined clinical and radiographic parameters, 38 patients underwent VATS immediately, whereas the remaining 82 were treated initially by means of tube thoracostomy. The latter was found to be sufficient for only 10 patients. Consequently, for the remaining 72 patients, it was decided to proceed also with VATS. The procedure was performed completely by VATS in 101 patients (91.8%), whereas in 9 patients (8.2%) it was necessary to convert to thoracotomy. The postoperative course was uneventful for 98 of the 110 patients (89%), whereas the remaining 12 patients experienced complications, including one case of persistent Empyema (0.9%) treated by thoracotomy. The mean chest tube duration was 6 days (range, 3–25 days). The mean postoperative hospital stay was 7.1 days (range, 5–17 days). Of the 80 patients completing a 6-month follow-up evaluation, the results were considered good for 72, moderately good for 8, and less than satisfactory for 2 patients. In conclusion, the authors consider VATS to be the technique of first choice for the treatment of Pleural Empyema when the disease is advanced or tube thoracostomy fails. It provides excellent results with a low level of invasiveness and considerably reduces the need for thoracotomy. These results can be achieved with good videothoracoscopic experience and the use of a very precise technique.
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Video thoracoscopic treatment in Pleural Empyema
Minerva Chirurgica, 2000Co-Authors: Solaini L, F. Prusciano, Di Francesco F, Paolo Bagioni, D. B. PoddieAbstract:To evaluate the possible role and the effectiveness of videothoracoscopy (VATS) in the treatment of Pleural Empyema. Personal experience on 40 cases of Pleural Empyema treated by (VATS) during 5 years is reported. The underlying diseases were: pneumonia (32), pneumothorax (3), tuberculosis (2), abdominal diseases (2) and lung cancer (1). Before VATS at least one thoracentesis was performed to evaluate the characteristic of the Pleural fluid. Due to complications related to thick Pleural adhesions, in one case (2.5%) the procedure was converted to open surgery, while in the remaining 39 cases VATS was able to achieve a complete cleaning of the Pleural space with re-expansion of the pulmonary parenchyma. The improvement of the clinical symptoms were observed after a mean period of 3.5 days (range: 1-12 days). Chest tube was removed in a mean period of 4.8 days (range: 3-11 days); five patients had prolonged air leak from 6 to 10 days after surgery. In conclusion we are of the opinion that VATS has to be considered a very important mean for the treatment of Pleural Empyema; its use in the fibrinopurulent phase of the disease should give very good results, while in the following phase its indications are controversial.
Georgios Stamatis - One of the best experts on this subject based on the ideXlab platform.
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video assisted thoracoscopy in the treatment of Pleural Empyema stage based management and outcome
The Journal of Thoracic and Cardiovascular Surgery, 1999Co-Authors: Paolo Claudio Cassina, Markus Hauser, L Hillejan, Dieter Greschuchna, Georgios StamatisAbstract:Abstract Objective: Despite modern diagnostic methods and appropriate treatment, Pleural Empyema remains a serious problem. Our purpose was to assess the feasibility and efficacy of the video-assisted thoracoscopic surgery in the management of nontuberculous fibrinopurulent Pleural Empyema after chest tube drainage treatment had failed to achieve the proper results. Methods: We present a prospective selected single institution series including 45 patients with Pleural Empyema who underwent an operation between March 1993 and December 1996. Mean preoperative length of conservative management was 37 days (range, 8–82 days). All patients were assessed by chest computed tomography and ultrasonography and underwent video-assisted thoracoscopic debridement of the Empyema and postoperative irrigation of the Pleural cavity. Results: In 37 patients (82%), video-assisted thoracoscopic debridement was successful. In 8 cases, decortication by standard thoracotomy was necessary. There were no complications during video-assisted thoracic operations. The mean duration of chest tube drainage was 7.1 days (range, 4–140 days). At follow-up (n = 35) with pulmonary function tests, 86% of the patients treated by video-assisted thoracic operation showed normal values; 14% had a moderate obstruction and restriction without impairment of exercise capacity, and no relapse of Empyema was observed. Conclusions: Video-assisted thoracoscopic debridement represents a suitable treatment for fibrinopurulent Empyema when chest tube drainage and fibrinolytics have failed to achieve the proper results. In an early organizing phase, indication for video-assisted thoracic operation should be considered in due time to ensure a definitive therapy with a minimally invasive intervention. For Pleural Empyema in a later organizing phase, full thoracotomy with decortication remains the treatment of choice. (J Thorac Cardiovasc Surg 1999;117:234-8)
Arvind Rengarajan - One of the best experts on this subject based on the ideXlab platform.
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thoracoscopic decortication a role for video assisted surgery in chronic postpneumonic Pleural Empyema
The Annals of Thoracic Surgery, 2001Co-Authors: David A Waller, Arvind RengarajanAbstract:Abstract Background . We evaluated a technique of video-assisted thoracoscopic (VAT) decortication of the visceral cortex to reexpand entrapped lung in cases of chronic postpneumonic Pleural Empyema. Methods . A prospective cohort study of 48 consecutive patients with multiloculated postpneumonic Pleural Empyema in whom visceral Pleural decortication was required was studied. The effect of VAT decortication on perioperative outcome and factors affecting its success were assessed. Results . Before the introduction of VAT decortication 12 patients were treated by thoracotomy (group T). In the subsequent 36 patients VAT decortication was attempted with success in 21 (group VS) but lung expansion was not observed in 15 patients (group VF) who required thoracotomy. There was no difference in the age or sex distribution of the 3 groups. Operating time was significantly longer in group T than group VS, mean difference 30.3 minutes ( p = 0.001) and postoperative hospital stay was longer in group T than group VS, mean difference 2.9 days ( p = 0.004). The success of VAT decortication was not related to either the delay between onset of symptoms or hospital admission and surgery; indeed the operating time decreased with increasing preoperative delay. However, success was related to increasing operative experience ( p = 0.001). Conclusions . VAT decortication is a feasible new technique to achieve lung reexpansion in chronic postpneumonic Pleural Empyema and has perioperative benefits over thoracotomy.
Jongcheol Park - One of the best experts on this subject based on the ideXlab platform.
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video assisted thoracoscopic decortication for management of postpneumonic Pleural Empyema
American Journal of Surgery, 2004Co-Authors: Bongsuk Oh, Wonchae Jang, Youngkyu Park, Jongcheol ParkAbstract:Abstract Background Video-assisted thoracoscopic surgery (VATS) for decortication or debridement in the management of Empyema thoracis has increased the available treatment options but requires validation. We present and evaluate our technique and experience with thoracoscopic management of Pleural Empyema, irrespective of chronicity. Methods From May 1, 2000, to April 30, 2002, VATS debridement and decortication in 70 consecutive patients presenting with Pleural space infections was performed with endoscopic shaver system. A retrospective review was performed and the effect of this technique on perioperative outcome was assessed. Results The VATS evacuation of infected Pleural fluid and decortication was successfully performed in 65 of 70 patients. The mean duration of preoperative symptoms before referral was 23 ± 1.8 days. The mean duration of hospitalization before transfer was 13.5 ± 1.5 days. Blood loss was 330 ± 200 mL. Intercostal drainage was required for 5 ± 3 days. The postoperative hospital stay was 5 ± 0.7 days. There were no operative mortalities. Conclusions Video-assisted thoracoscopic decortication with endoshaver system is a simple and effective method in the management of the fibropurulent or organic Pleural Empyema.
Massimo Martelli - One of the best experts on this subject based on the ideXlab platform.
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chronic postpneumonic Pleural Empyema comparative merits of thoracoscopic versus open decortication
European Journal of Cardio-Thoracic Surgery, 2009Co-Authors: Giuseppe Cardillo, Francesco Carleo, Luigi Carbone, Marco Di Martino, Lorenzo Salvadori, Lea Petrella, Massimo MartelliAbstract:Objective:We seekto evaluatethecomparativemeritsofthoracoscopicversusopendecorticationinthesurgicalmanagementofpatientswith chronic postpneumonic Pleural Empyema.Methods:From January 1996 to December 2006, 308 patients (180 males, 128 females, mean age: 56.3 years, range: 17—82 years) with chronic postpneumonic Pleural Empyema underwent decortication after failure of conservative treatment. Results: Decortication was performed by open thoracotomy in 123 (39.9%) patients (OT) and by videothoracoscopy (VT) in 185 (60.1%). Mortality was 1.29% (4/308). Morbidity was 21.1% (65/308). At 6 months follow-up, three VT patients showed recurrent Empyema and underwent re-do surgery by video-assisted-thoracoscopy (VATS) (one patient) or by thoracotomy (two patients). The videothoracoscopic approach showed statistically significant better results in terms of in-hospital postoperative (day 1 and day 7), pain (p < 0.0001), postoperative air leak ( p= 0.004), operative time (p < 0.0001), hospital stay (p = 0.020) and time to return to work (p < 0.0001). The analysis of postoperative pain at 6 monthsfollow-upshowednosignificantdifferencesamongthedifferentgroups.Conclusions:In thelightofourexperience,videothoracoscopic decortication appears to be the surgical treatment of choice for chronic postpneumonic Pleural Empyema even if a multicentric-randomised trial should be performed before videothoracoscopic decortication becomes the gold standard for the treatment of Pleural Empyema. # 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.