Video-Assisted Thoracoscopic Management of Post-Pneumonectomy Empyema

Background: Post-pneumonectomy empyema is a major therapeutic challenge in thoracic surgery. The presence or absence of a concomitant bronchopleural fistula directs treatment of this condition. When there is no bronchopleural fistula the condition is classically treated with thoracostomy drainage, irrigation and antibiotic instillation with closure. This approach is, however, associated with a significant rate of primary failure. Alternative modified techniques involve opening the thoracic cavity widely with serial debridement followed by interval closure. Multiple surgical procedures often require a protracted hospital stay. Methods: We describe a technique in three patients utilizing video-assisted thoracoscopic surgery for debridement and closure of the pneumonectomy cavity. Conclusion: Advantages of this technique include debridement under direct visualization, low morbidity, and potential for a shorter hospital stay.