Nonintubated VATS Combined with Pleurodesis and PleurX Catheter in Patients with Recurrent Pleural Effusions

Background: Pleurodesis by video-assisted thoracoscopic surgery (VATS) in recurrent malignant pleural effusions is an established procedure in overall palliative concepts. The aim is to improve quality of life especially dyspnea of these patients. In addition to pleurodesis, PleurX catheter system is an alternative in therapy failure or palliative situation. In clinical routine VATS pleurodesis is performed using one lung ventilation. Nonintubated VATS (NI-VATS) offers potential benefits in multimorbid patients avoiding anesthesia. A combination of talc pleurodesis and PleurX catheter placement may increase the success rate. We present our first experiences with this new combined concept of NI-VATS, talc pleurodesis, and PleurX catheter.

Method: We retrospectively analyzed the first 32 patients treated with a combined concept of NI-VATS, talc pleurodesis, and PleurX catheter over a period of 2.5 years. Patient's demographics, operations, clinical course, and mortality were evaluated.

Results: All 32 patients (male: 53.1%, female: 46.9%) aged 73.9 ± 10.5 years had clearly restricted general conditions and severe dyspnea before operation. Causes of recurrent pleural effusion were malignancy in 22 patients (68.7%) and nonmalignant (cardiac/renal insufficiency) in 10 patients (31.3%). Patients received NI-VATS, pleurodesis, PleurX catheter placement, and biopsy (46.9%) using a uniportal technique. The operating time was 38.5 ± 16.9 minutes. In one patient, circulatory instability occurred intraoperatively successfully treated with catecholamines. There were no intraoperative intubations. Three patients died during clinical course due to their underlying disease (mortality: 9.4%). Twenty-nine patients (90.6%) were discharged from hospital. All patients showed a clear clinical improvement of dyspnea.

Conclusion: A combined concept of NI-VATS, talc pleurodesis, and PleurX, catheter placement can be promising in multimorbid and palliative patients as more than 90% of patients could be discharged in our collective. Patients with a nonmalignant effusion also benefited from the operation, so that this new concept can also be a treatment option for this patient group.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
28 January 2023