Diagnostic and therapeutic performance of video-assisted thoracoscopic surgery (VATS) in investigation and management of pleural exudates. Ann R Coll Surg Engl 2008 Oct;90(7):597-600
Date
08/15/2008Pubmed ID
18701011Pubmed Central ID
PMC2728309DOI
10.1308/003588408X318246Scopus ID
2-s2.0-55049085937 (requires institutional sign-in at Scopus site) 24 CitationsAbstract
INTRODUCTION: Video-assisted thoracoscopic surgery (VATS) is the gold standard investigation for diagnosis of pleural exudates. It is invasive and it is important to ensure that it is performed to acceptable national standards. We assumed that VATS empyema fluid culture would not contribute further to microbiological diagnosis in referred culture-negative empyemas.
PATIENTS AND METHODS: Eighty-six consecutive external referrals for VATS for diagnosis of a cytology-negative pleural exudate (or for further management of the exudate) were studied retrospectively. Diagnostic yield, pleurodesis efficacy and complications were compared to national standards and good practice recommendations. VATS empyema fluid microbiological culture results were compared to pre-VATS empyema fluid culture results.
RESULTS: VATS was performed well within national standards with a diagnostic yield of 82.3% for cytology-negative exudates, 100% pleurodesis efficacy, 5.8% postoperative fever, with only one significant complication (1.2% rate) and no deaths. Compliance with good practice pleural fluid documentation points was greater than 70%. VATS empyema fluid culture positivity (84.6%) was significantly higher than pre-VATS fluid culture (35%).
CONCLUSIONS: VATS was performed to acceptable standards. These data confirm the utility and safety of VATS in the right context but also suggest the potential diagnostic utility of VATS empyema fluid culture. Further studies are required to investigate this latter possibility further.
Author List
Medford AR, Awan YM, Marchbank A, Rahamim J, Unsworth-White J, Pearson PJAuthor
Paul Joseph Pearson MD, PhD Chief, Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Exudates and TransudatesFemale
Humans
Male
Medical Audit
Middle Aged
Neoplasms
Pleural Effusion
Referral and Consultation
Retrospective Studies
Thoracic Surgery, Video-Assisted