Use of Thoracoscopy for Treatment of Empyema in Children

Empyema has traditionally been managed by a combination of antibiotic therapy and chest drainage. Advanced cases have required surgical debridement of infected pleural debris. In the past, this was accomplished with a thoracotomy or minithoracotomy. Such procedures were often delayed in the hope that their morbidity could be avoided. However, advanced empyema carries its own morbidity. Moreover, resolution of empyema is usually hastened by aggressive surgical debridement of the pleural space if antibiotics and drainage have been unsuccessful. Thoracoscopy now allows surgical debridement with potentially less morbidity than traditional surgical procedures. This, in turn, may encourage earlier surgical debridement, thus avoiding the sequelae of advanced empyema. This review discusses thoracoscopy as treatment for empyema with illustrative case reports.