Abstract
Two nontuberculous acute empyema cases with a thick pleural peel were successfully treated by thoracoscopic surgery. The patients were 59 and 52 year old males, for whom the surgery was performed on the 38th and 17th day from the onset of empyema symptoms respectively. Thickened purulent thoracic wall was suspected before surgery in both cases. Because of the thick peel, sufficient lung decortication was considered difficult to accomplish by direct thoracoscope insertion into the purulent thoracic cavity. Therefore the thoracoscope was inserted into the layers outside the purulent cavity, namely into the gap between the purulent thoracic wall and visceral pleura, under thoracoscopic view, to break adhesions between the purulent wall and visceral pleura (outer approach to purulent thoracic cavity). After the entire purulent thoracic wall was checked from the outside of the purulent thoracic cavity, the thickened peel was safely removed. Even for acute thoracic empyema with a thickened peel, thoracoscopic surgery can be successfully performed by this approach as long as visceral pleura can be detached from the adjoining purulent wall.
