The use of single incision thoracoscopic pleurectomy in the management of malignant pleural effusion

Abstract

Background: A number of procedures have been used in the management of malignant pleural effusion including repeated thoracentesis, tube thoracostomy, drainage with catheter, chemical pleurodesis, pleurectomy and pleuro-peritoneal shunt. However, the optimal method of management remains unclear. On the other hand, single incision thoracoscopic surgery has been defined as a less invasive method than the standard threeportal videothoracoscopy. We herein present our series of patients who underwent single incision thoracoscopic pleurectomy for malignant pleural effusion.

Patients and methods: We performed a single incision thoracoscopic pleurectomy in a total of 19 consecutive patients, 11 (57.8%) male and 8 (42.2%) female with a mean age of 56.3 +/- 16.9 years who had malignant pleural effusions. We made a single 2-2.5 cm incision at the seventh or eighth intercostal spaces on the midaxillary line for the procedure.

Results: We performed a total of 23 single incision thoracoscopic total pleurectomies consisting of 11 (57.8%) right-sided, 4 (21.1%) left-sided and 4 (21.1%) bilateral procedures. The mean total postoperative drainage was 553 +/- 266 cc (Median; 470 cc), and the mean chest tube removal time was 2.3 +/- 0.4 days (Median; 2 days). We observed neither morbidity nor mortality. No patient required an additional port or a conversion to thoracotomy. Median follow-up was 83 days (range, 30 to 359 days). Pleural effusion recurred in two (8.6%) out of 23 procedures which resulted in a success rate as 91.4% for the procedure.

Conclusion: Single incision thoracoscopic pleurectomy is a safe, less invasive and an effective method of pleurodesis with a low recurrence rate in patients with malignant pleural effusion.