Hippocrates quoted ‘If an empyema does not rupture, death will occur’. Is single port medical thoracoscopy (S-MT) able ‘to make it safely rupture’?

Introduction: Medical thoracoscopy has been a useful minimal invasive modality in the hands of experienced operators and has gradually evolved into even less invasive approaches. Objective: To evaluate the safety and efficacy of S-MT for the treatment of empyema thoracis in stages I-II. Material and methods: Retrospective multicentre study of 104 patients with empyema (stage I-II) who underwent medical thoracoscopy between January 2001-November 2014. Results: One hundred and four patients (81 males, 23 females) underwent S-MT for pleural empyema in stage I (12/104 patients) and II (92/104 patients). Median age was 61.8 years (range, 18-84 years). Macroscopically complete debridement of the pleural cavity was achieved in 88/104 patients (84.6%) while the remaining required VATS/open decortication due to trapped-lung syndrome. Median procedure time was 45 minutes (range, 30-94 minutes). No intraoperative complications were recorded. In-hospital mortality was zero whereas in-hospital morbidity rate was 16.7%. Median hospital stay was 7.8 days (range 3-18 days). Recurrence rate was 4.16%. Conclusions: S-MT is a minimally-invasive, safe and effective procedure for the treatment of stage I-II empyemas with low recurrence rates. It improves patient outcomes while at the same time it entails short uncomplicated hospital admissions thereby decreasing admission costs and effectively relieving bed pressures.