Initial Thoracoscopic Access for Complicated Pleural Empyema

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Abstract
Even though the advantages of thoracoscopy for complicated pleural empyema are well recognized by most authors, the initial access and the creation of an acceptable surgical field are difficult. The authors describe an original technique that makes this procedure easier to perform in these cases. Five patients with a mean age of 86 months (range 10 months to 14 years) with complicated pleural empyema are presented. All patients received general anesthesia. A device made with a finger of a latex glove was attached to a disposable intravenous (IV) plastic infusion set BT-26 Biom® with 4-0 silk and inserted through the first trocar. At the remaining end of the IV plastic infusion set, a 60-ml syringe was attached. The balloon (finger of a latex glove) was insufflated inside the thorax with 300–500 ml of saline. Then the device was deflated and removed, and an acceptable surgical field was therefore created. The procedure was satisfactory in all five patients. Mean surgical time was 64 min (range 40–90 min). There were no complications. The insufflation of the balloon caused no respiratory or circulatory complications. Patients were discharged at a mean of 7.2 days. This procedure was highly effective, safe, and inexpensive. All these features make this procedure a useful tool for the initial management of complicated pleural empyema.

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