[Video-assisted thoracoscopic surgery (VATS) for treatment of pleural empyema].

During 1996-2003 a total of 359 patients were treated for empyema. Forty eight of them (with parapneumonic empyema) were prospectively randomized into 2 groups of 24 patients who underwent early decortication either by thoracotomy or VATS. Comparing to thoracotomy group, VATS group had a significantly shorter chest tube duration (5.8+/-1.1 vs 9+/-1.3 days; p=0.03) and postoperative in-hospital stay with parapneumonic empyema (8.7+/-0.9 vs 12.8+/-1.1 days; p=0.009). VATS has been found to be particularly useful for treating the fibrinopurulent phase of empyema, in which multiple loculations could be easily disrupted to allow adequate drainage of a "cleaned" pleural space. On the other hand, although VATS is highly effective, it is not indicated in every patient and it's indiscriminate use may lead to none required operative interventions.