THE ROLE OF VIDEO-ASSISTED THORACOSCOPY VATS IN THE DIAGNOSIS AND TREATMENT OF PLEURAL EMPYEMA

Abstract

Pleural empyema is a severe infectious condition that manifests itself with the presence of a purulent collection in the pleural space. It most often develops as a consequence of bacterial pneumonia, but can also occur after traumatic injuries, surgical interventions or through the continuous spread of infection from surrounding anatomical structures. The disease represents a serious clinical challenge due to its complex course and the need for a multidisciplinary approach to treatment. If not diagnosed and treated promptly, empyema can lead to significant morbidity and an increased risk of lethal outcome. From a pathophysiological point of view, pleural empyema progresses through three clearly defined stages. The initial, exudative phase, is characterized by aseptic accumulation of pleural fluid as a consequence of a local inflammatory process. In the fibrinopurulent stage, microbial contamination occurs, followed by increased infiltration of inflammatory cells and deposition of fibrin, which results in the formation of septa and limitation of the purulent collection. The final, organizational phase involves thickening of the pleural sheets and the formation of a fibrous membrane, which can significantly compromise lung expansion and contribute to the development of chronic respiratory dysfunction.
The clinical presentation most often includes elevated body temperature, cough with expectoration, chest pain, shortness of breath and general weakness. The diagnostic process is based on the integration of clinical findings, laboratory markers of inflammation and modern imaging techniques, including radiography, ultrasonography and computed tomography of the chest.
Video-assisted thoracoscopy (VATS) is a modern minimally invasive surgical approach that allows direct visual assessment of the pleural space through a thoracoscope connected to a video system. The procedure is performed through several small thoracic incisions, which significantly reduces operative trauma, shortens the recovery period and reduces the incidence of postoperative complications.
The method provides detailed insight into the morphological changes of the pleura and lung parenchyma, which has particular diagnostic value in patients with etiologically unclear pleural effusion. In addition, VATS allows for targeted biopsies, confirmation of the diagnosis of pleural empyema, and exclusion of other pathological conditions, including malignant processes and tuberculosis.