This video describes robotic-assisted decortication for a recurrent pleural effusion secondary to fibrothorax. Technical aspects of the decortication are demonstrated, including port placement, robot docking, and closure.
Decortication is occasionally needed for an infected pleural space or recurrent pleural effusion caused by a trapped lung resulting from fibrothorax or malignant process (1). Outcomes of video-assisted thoracoscopic decortication have been shown to reduce complications and mortality (2), and conversion to open thoracotomy is more frequent with longer duration of the empyema or fibrothorax (3). Lung decortication, which re-expands the affected lung, has been shown to improve the quality of life in patients with trapped lungs following coronary artery bypass grafting (4).
References
- Rathinam S, Waller, DA. Pleurectomy decortication in the treatment of the “trapped lung” in benign and malignant pleural effusions. Thorac Surg Clin. 2013;23(1):51-61.
- Tong BC, Hanna J, Toloza EM, et al. Outcomes of video-assisted thoracoscopic decortication. Ann Thorac Surg. 2010;89(1):220-225.
- Landreneau RJ, Keenan RJ, Hazelrigg SR, Mack MJ, Naunheim KS. Thoracoscopy for empyema and hemothorax. Chest. 1996;109(1):18-24.
- Celik S, Celik M, Aydemir B, Tunckaya C, Okay T, Dogusoy I. Long-term results of lung decortication in patients with trapped lung secondary to coronary artery bypass grafting. Ann Thorac Cardiovasc Surg. 2012;18(2):109-114.
Dr Jeff is a proctor and speaker for Intuitive Surgical, Inc.
Interesting. Appears to be a very early fibrino-purulent empyema which may make robotic decortication likely successful.