ArticleJournal of thoracic disease2026
Early source control with non-intubated uniportal video-assisted thoracoscopic surgery for acute thoracic empyema: a retrospective pilot cohort study.
Article in Journal of thoracic disease, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Acute thoracic empyema often develops in older and frail patients, in whom treatment selection can be challenging. This retrospective pilot cohort study evaluated the clinical outcomes of non-intubated uniportal video-assisted thoracoscopic surgery (NI-uVATS) as a potential early source-control strategy for selected patients with acute thoracic empyema. Methods: We retrospectively reviewed 41 consecutive patients with acute thoracic empyema who underwent NI-uVATS between July 2019 and June 2025. NI-uVATS was performed as the initial procedure in 32 patients (initial group) and after prior chest drainage in 9 patients (post-drainage group). The procedure was performed through a 3-4 cm uniportal incision under local anesthesia with sedation and included thoracoscopic septal disruption, large-volume saline irrigation, and chest tube placement. Clinical characteristics, operative findings, postoperative outcomes, complications, and microbiological results were analyzed. Results: The cohort consisted mainly of older patients, and poor performance status was present in 13/32 and 3/9 patients, respectively. The thoracoscopic procedure was completed through the uniportal approach in all patients; however, one patient required intraoperative conversion to general anesthesia with endotracheal intubation because of excessive sputum and oxygen desaturation. Operative time was significantly shorter in the initial group than in the post-drainage group [83 (interquartile range: 66.5-98.8) Conclusions: NI-uVATS may be a feasible early source-control option for selected patients with acute thoracic empyema. However, because treatment escalation events occurred in some patients and this was a retrospective pilot cohort study, these findings should be interpreted as exploratory and require validation in larger comparative studies.
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