A video assisted thoracoscopic (VATS) decortication is a minimally invasive procedure to remove the empyema or hemothorax from the pleural space. This procedure is performed under general anesthesia with lung isolation. The patient is positioned on the table on their side. Three (1 to 1.5 cm) incisions are made on the chest wall to perform the procedure. The lung is separated from the chest wall, mediastinum and the diaphragm and the pockets of loculated infection or blood clot are removed from the pleural space. Then the rind covering the lung is peeled off of the lung which allows the lung to expand. Next, the chest cavity is washed out and two large chest tube are placed in the pleural space to drain the air and fluid.
VATS lung decortication is a safe and effective treatment for empyema. However, if it is not possible to remove all of the infected material in the pleural space, this method becomes dangerous and your surgeon may need to make the prudent decision to continue by making the traditional incision to safely complete the operation. This should not be seen as a failure, but as a wise decision by your surgeon to prevent dangerous complications. Other complications include bleeding and injury to the lung. There is a small possibility to require a blood transfusion for this operation. There are also a rare complication of injury to the phrenic nerve, diaphragm and pericardium. There is very rare chance of recurrence of the empyema and dying from the procedure.
After the operation, most patients will wake up with two to three chest tube on the side of the operation. These will be removed once there is minimal drainage and no air leak. You will be in the hospital to recover from the operation for 3-5 days. Once the chest tubes are removed and your pain is well controlled on oral pain medication, you will be discharged home.
Long Term Outcome
Most of the patients will have resolution of the empyema or hemothorax after the procedure and they will not require additional therapy.