Skip to main content Skip to main navigation menu Skip to site footer

Video-assisted thoracoscopic surgery in the treatment of empyema: a case series


Background: Empyema is a condition that can be treated depending on the etiology of the empyema and the phase of empyema development. Open thoracotomy surgery is a conventional technique commonly used in empyema that has greater risk and more extended postoperative hospital stay. This case series aims to evaluate Video-Assisted Thoracoscopic Surgery (VATS) to shorten postoperative hospital stay and lower the risk during the surgery.

Case Presentation: We describe a case series of empyema in five patients, each with a different presentation, clinical course, and outcome. All of our patients were performed VATS procedures under General Anesthesia and evaluated for postoperative hospital stays and complications that occur after the surgery. Most of the patients experienced tolerable pain on the site of surgery and only need 3 – 4 days post-operation hospital stays after VATS before being discharged. Only one patient with a poor prognosis after VATS in this case series caused the patient to be admitted to the Intensive Care Unit and using a mechanical ventilator.

Conclusion: In this case series, VATS has a promising result for the patient and can become a choice of treatment for empyema.


  1. Hamm H, Light RW. Parapneumonic effusion and empyema. Eur Respir J. 1997;10(5):1150-1156.
  2. Subotic D, Lardinois D, Hojski A. Minimally invasive thoracic surgery for empyema. Breathe (Sheff). 2018;14(4):302-310.
  3. Farjah F, Symons RG, Krishnadasan B, Wood DE, Flum DR. Management of pleural space infections: a population-based analysis. J Thorac Cardiovasc Surg. 2007;133(2):346-351.
  4. Finley C, Clifton J, Fitzgerald JM, Yee J. Empyema: an increasing concern in Canada. Can Respir J. 2008;15(2):85-89.
  5. Taylor MD, Kozower BD. Surgical spectrum in the management of empyemas. Thorac Surg Clin. 2012;22(3):431-440.
  6. Maskell NA, Davies CW, Nunn AJ, Hedley EL, Gleeson FV, Miller R, et al. U.K. Controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med. 2005;352(9):865-74.
  7. Semenkovich TR, Olsen MA, Puri V, Meyers BF, Kozower BD. Current State of Empyema Management. Ann Thorac Surg. 2018;105(6):1589-1596.
  8. Iuchi K, Tanaka H, Nakamura K. Pathogenesis and treatment of chronic empyema. Nihon Geka Gakkai Zasshi. 2004;105(12):751-6.
  9. Scarci M, Abah U, Solli P, Page A, Waller D, van Schil P, et al. EACTS expert consensus statement for surgical management of pleural empyema. Eur J Cardiothorac Surg. 2015;48(5):642-53.
  10. Jiménez Castro D, Díaz G, Pérez-Rodríguez E, Light RW. Prognostic features of residual pleural thickening in parapneumonic pleural effusions. Eur Respir J. 2003;21(6):952-955.
  11. Hooper C, Lee YC, Maskell N, BTS Pleural Guideline Group. Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65 Suppl 2:ii4-ii17.
  12. Perikleous P, Rathinam S, Waller DA. VATS and open chest surgery in diagnosis and treatment of benign pleural diseases. J Vis Surg. 2017;3:84.
  13. Reichert M, Hecker M, Witte B, Bodner J, Padberg W, Weigand MA, et al. Stage-directed therapy of pleural empyema. Langenbecks Arch Surg. 2017;402(1):15-26.
  14. Wilson H, Mohite P, Hall A, Anikin V. Timing and Efficacy of VATS Debridement in the Treatment of Parapneumonic Empyema. Archives of Pulmonology and Respiratory Care. 2016;2(1):016-019.
  15. Reichert M, Pösentrup B, Hecker A, Schneck E, Pons-Kühnemann J, Augustin F, et al. Thoracotomy versus video-assisted thoracoscopic surgery (VATS) in stage III empyema-an analysis of 217 consecutive patients. Surg Endosc. 2018;32(6):2664-2675.
  16. Wozniak CJ, Paull DE, Moezzi JE, Scott RP, Anstadt MP, York VV, et al. Choice of first intervention is related to outcomes in the management of empyema. Ann Thorac Surg. 2009;87(5):1525-30.
  17. Chambers A, Routledge T, Dunning J, Scarci M. Is video-assisted thoracoscopic surgical decortication superior to open surgery in the management of adults with primary empyema?. Interact Cardiovasc Thorac Surg. 2010;11(2):171-177.
  18. Majeed FA, Chatha SS, Zafar U, Chatha UF, Chatha AZ, Farooq Z. Surgical Management of Paediatric Empyema: Open Thoracotomy versus Video-assisted Thoracic Surgery. J Coll Physicians Surg Pak. 2020;30(3):309-312.
  19. Pan H, He J, Shen J, Jiang L, Liang W, He J. A meta-analysis of video-assisted thoracoscopic decortication versus open thoracotomy decortication for patients with empyema. J Thorac Dis. 2017;9(7):2006-2014.
  20. Heffner JE, Klein JS, Hampson C. Diagnostic utility and clinical application of imaging for pleural space infections. Chest. 2010;137(2):467-79.
  21. Bongiolatti S, Voltolini L, Borgianni S, Borrelli R, Tancredi G, Viggiano D, et al. Uniportal thoracoscopic decortication for pleural empyema and the role of ultrasonographic preoperative staging. Interact Cardiovasc Thorac Surg. 2017;24(4):560-566.

How to Cite

Wirawan, Y. R., & Tansil, C. J. (2021). Video-assisted thoracoscopic surgery in the treatment of empyema: a case series. Bali Medical Journal, 10(1), 89–94.




Search Panel

Yustinus Rurie Wirawan
Google Scholar
BMJ Journal

Christophoroes Jonathan Tansil
Google Scholar
BMJ Journal