COMPARISON OF LUNG EXPANSION AFTER UNIPORTAL AND MULTIPORTAL VIDEO ASSISTED THORACIC SURGERY FOR STAGE II POST-PNEUMONIC BACTERIAL EMPYEMA THORACIS
Abstract
Background and Objectives:
Background: Empyema is a condition that thoracic surgeons encounter in daily practice. Traditionally, the surgical approach was open thoracotomy; then the multiportal VATS approach became more common. Recently, more surgeons are adopting the uniportal VATS approach, which has become a powerful surgical tool for managing stage II empyema.
Objectives: To evacuate the pus and fibrin deposits in the thoracic cavity for complete lung expansion.
Methods: It was a parallel-armed randomized control study in which 160 patients admitted to the (Department name), (Hospital name), Lahore were included. The patients were divided into two equal groups (80 in each group). (Uniportal group) Group-A patients underwent uniportal VATS, while (Multiportal group) Group B patients were treated with multiportal VATS. Simple consecutive sampling was carried out. Expansion of lung was evaluated postoperatively at the 1st, 3rd, 7th and 15th postoperative day by chest radiograph after uniportal and multiportal VATS.
Results: The age of patients ranged from 20 to 73 years, with a mean age of 35.73 ± 10.67 years. The mean operative time was 211.08 ± 12.92 minutes in group A and 226.94 ± 9.75 minutes in group B. Mean intraoperative blood loss was also 47.73 ± 11.11 ml in group A and 97.49 ± 15.67 ml in group B. Lung re-expansion was observed in 76 (95%) patients in group A and 75 (93.75%) patients in group B. Postoperative pain scores on the visual analogue scale in group A were 3.48 ± 0.75 on day 1, 2.63 ± 0.40 on day 3, and 2.22 ± 0.53 on day 7. In group B, postoperative pain scores were 3.95 ± 0.87, 3.05 ± 0.81, and 2.53 ± 0.67 on days 1, 3, and 7, respectively.
Conclusion: Uniportal and multiportal VATS are feasible treatment options in all patients with pleural empyema requiring surgery. In our study, we observed comparable postoperative success rates, no need for conversion, and successful completion of decortication via both multiportal and uniportal approaches. The transition to a single-incision technique was associated with fewer chest tubes, minimal surgical trauma, and no compromise in clinical outcomes.
