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eComment: The role of video-assisted thoracoscopic surgery in the management of tuberculous empyemas

Thoracic Surgery Department, Theagenio Hospital, A. Simeonidi 2, 54007 Thessaloniki, Greece

The role of surgery in the management of pleuropulmonary tuberculosis – seven years' experience at a single institution

We read with great interest Kerti and colleagues' remarkable experience with the surgical management of pleuropulmonary tuberculosis [1]. The role of surgical intervention in tuberculosis has decreased dramatically with the advent of powerful antituberculous drugs.

Our institute's surgical experience with the disease has been similar to that of the authors and could be summarized in two points: 1. Very few of the chronically-collapsed lungs expand, even after drainage of the empyema and even after decortication; 2. Complication rates after resectional surgery are forbidding, with high rates of parenchymal air leaks and bronchopleural fistula.

Minimally invasive techniques like VATS are increasingly used and provide a new approach to the management of pleuropulmonary tuberculosis [2]. It is certain that the increased and ongoing experience with VATS will allow us to perform more sophisticated procedures in the near future. According to our experience, the use of VATS for tuberculous empyemas is effective only for stage II empyemas. Open thoracotomy and decortication is indicated for stage III empyemas. Extreme narrowing of the intercostal spaces and thickened parietal peel, make introduction of the thoracoports and manipulation of the endoscopic instruments very difficult. Thus assessment of and judgement as to whether an optimal peeling has been gained without causing excessive air leak are difficult via thoracoscope and consequently require extreme experience.

We conclude that VATS provides a safe, effective diagnostic (pleural biopsy, wedge resections) and therapeutic modality (decortications, drainage of stage II empyema) for selected patients with pulmonary tuberculosis.

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1. Kerti CA, Miron I, Cozma GV, Burlacu ON, Tunea CP, Voiculescu VT, Memu EF, Nicodin AC. The role of surgery in the management of pleuropulmonary tuberculosis – seven years' experience at a single institution. Interact CardioVasc Thorac Surg 2009;8:334–338.[Abstract/Free Full Text]
2. Olgac G, Yilmaz MA, Ortakoylu MG, Kutlu CA. Decision-making for lung resection in patients with empyema and collapsed lung due to tuberculosis. J Thorac Cardiovasc Surg 2005;130:131–135.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Nikolaos Barbetakis Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Barbetakis, N. Articles by Tsilikas, C. Search for Related Content PubMed PubMed Citation Articles by Barbetakis, N. Articles by Tsilikas, C. Related Collections Related Article