I. First procedure
septicaemia, empyema, MIN
SEPTICAEMIA, COLLAPSE, EMPYEMA, CAVITY, PLEURAL EMPYEMA, DECUBITUS
Following the diagnosis of pleural empyema, either sonographic or CT-guided drainage placement was performed as first-line treatment in combination with empiric antibiotic therapy. Surgery was performed 1–4 days following drainage placement, depending on the condition of the patient, with septicaemia warranting earlier surgical intervention, while stable patients were surgically treated after treatment initiation via drainage and antibiotic therapy.At the first surgical intervention, all patients received a double-lumen tube or bronchial blocker, so the relevant lung could collapse by suction if needed. The procedure was performed with the patient in the lateral decubitus position.First, the drainage channel was widened to safely reach the empyema cavity, and an endoscope [usually a standard gastroscope (8–10 mm wide)] was introduced (Fig. Step-by step approach for FlexVATS technique. (The second step was the insertion of black or white sponge segments (3M™ V.A.C. Granufoam™, 3M St. Paul, MIN, or V.A.C. WHITEFOAM™ Small Dressing) or open pore film material (Suprasorb CNP by Lohmann & Rauscher, Germany). The sponges were cut into long cuboids that could be inserted through mini-thoracotomy, with extracorporeal fixation of the ends using a non-absorbable suture for easier extraction (Fig. 