• Stefano Bongiolatti, Luca Voltolini, Sara Borgianni, Roberto Borrelli, Giorgia Tancredi, Domenico Viggiano, and Alessandro Gonfiotti.
• Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy.
• Interact Cardiovasc Thorac Surg. 2017 Apr 1; 24 (4): 560-566.

ObjectivesThe surgical approach to chronic pleural empyema is still controversial. Video-assisted thoracic surgery (VATS) debridement and decortication has shown favourable outcomes, while the uniportal VATS (U-VATS) approach is still anecdotal. We report our experience with ultrasonographic (US) preoperative staging followed by U-VATS decortication for pleural empyema.MethodsWe performed a retrospective analysis of patients who underwent surgical treatment of stage II and stage III pleural empyema from 2012 to 2015. Pre-, intra- and postoperative data were investigated to evaluate outcomes including postoperative complications and disease recurrence. Results were analysed according to preoperative US appearance of pleural space (stages A-E) and surgical approach (thoracotomy vs U-VATS).ResultsWe performed 30 (47%) uniportal thoracoscopic pleural decortication and 34 (53%) open decortication for empyema in stage II (40%) or III (60%) obtaining a complete debridement and decortication in all patients. In-hospital mortality was zero and overall morbidity was 29%. U-VATS was associated with lower blood loss (118 ±  80 ml vs 247  ±  140 ml P  < 0.001), lower chest tubes duration (5.6 ±  1.4 vs 10.6  ±  4.4 days P  < 0.001), shorter hospital stay (6.7  ±  1.9 vs 12.2  ± 4.7 days, P  < 0.001) and lower complications (10% vs 16%, P  < 0.001). Elevated US patterns (D-E) are associated with thoracotomy, higher blood loss, operative time and a significant incidence of complications.ConclusionsUniportal thoracoscopic decortication for pleural empyema is a safe and effective approach for selected patients based on a combination of clinical and imaging staging. US patterns well corresponded with intraoperative pleural findings and showed a prognostic value.© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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