Medical College of Wisconsin
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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

08/15/2008

Pubmed ID

18701011

Pubmed Central ID

PMC2728309

DOI

10.1308/003588408X318246

Scopus ID

2-s2.0-55049085937 (requires institutional sign-in at Scopus site)   24 Citations

Abstract

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 PJ

Author

Paul Joseph Pearson MD, PhD Chief, Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Exudates and Transudates
Female
Humans
Male
Medical Audit
Middle Aged
Neoplasms
Pleural Effusion
Referral and Consultation
Retrospective Studies
Thoracic Surgery, Video-Assisted