A comparative study of uniportal video-assisted thoracic surgery versus thoracotomy in the treatment of TB empyema

Our plain-English summary of A comparative study of uniportal video-assisted thoracic surgery versus thoracotomy in the treatment of TB empyema, by H. Liu, P. Xu, S. Zheng, et al (IJTLD Open, 2026).

The study

• Authors: H. Liu, P. Xu, S. Zheng, X. Wang, Y. Long, S. Lin, Y. Wang, J. Zeng, M. Fang, K. Qiao, S. Lu, H. Wang
• Journal: IJTLD Open
• Published: 2026;3(8):488-493
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Chronic TB empyema is a serious complication of TB that often requires surgery because drug penetration into fibrotic pleural tissue is poor. We compared uniportal video-assisted thoracic surgery (VATS) and thoracotomy for pleural decortication.

Methods: We retrospectively analysed 112 patients with chronic TB empyema who underwent surgical treatment between 2020 and 2024. Thoracic morphometric changes were assessed using pre- and postoperative computed tomography, and factors associated with postoperative thoracic expansion were explored.

Results: Of the 112 patients, 65 underwent thoracotomy and 47 uniportal VATS. The overall excellent/good outcome rate was 91.9%, based on postoperative lung re-expansion, residual empyema cavity and residual fibrous pleural plaque. Compared with thoracotomy, uniportal VATS was associated with less intraoperative blood loss (151.8 ± 127 vs. 278 ± 231 mL, P < 0.001) and a shorter postoperative hospital stay (8.2 ± 3.7 vs. 9.9 ± 3.1 days, P = 0.002). Both groups showed significant postoperative improvement in thoracic morphometric measurements. Older age was associated with poorer postoperative thoracic expansion.

Conclusion: In this retrospective single-centre cohort, uniportal VATS was associated with more favourable perioperative outcomes than thoracotomy, with comparable short-term radiographic recovery.

© 2026 The Authors.

In plain English

This study is not about asbestos. It retrospectively reviewed 112 patients at Shenzhen Third People's Hospital, China, operated on between June 2020 and June 2024 for chronic tuberculous (TB) empyema: pus in the pleural space with scarring of the pleura, the lining around the lung. Sixty-five had open surgery (thoracotomy) and 47 single-incision keyhole surgery (uniportal VATS). Choice of operation mostly reflected a change in hospital practice over time. The VATS group had less blood loss during surgery (average 151.8 vs 278 mL) and shorter postoperative hospital stays (8.2 vs 9.9 days). The groups did not differ significantly in operating time or short-term imaging recovery. All patients completed 12 months of follow-up. Overall, 58 had excellent, 45 good and 9 fair results (91.9% excellent or good). Nineteen (17.0%) had complications, and none died during follow-up. In exploratory analysis, older age was associated with less chest expansion. The "fibrous pleural plaque" graded here was residual fibrous pleural tissue after TB empyema surgery. The authors concluded VATS was associated with favourable short-term outcomes but said the study cannot show superiority.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective single-centre cohort study comparing two surgical approaches
• Who was studied: 112 patients (87 men, 25 women; mean age 36.4 years, range 5 to 85) with chronic TB empyema who had surgery at Shenzhen Third People's Hospital, China, between June 2020 and June 2024. Patients with drug-resistant TB were excluded.
• Exposure: No asbestos or other fiber exposure was studied. The study compared two surgical approaches for pleural decortication: thoracotomy (65 patients) and uniportal video-assisted thoracic surgery (47 patients).
• Main results:
  • Compared with the thoracotomy group, the uniportal VATS group had less intraoperative blood loss (mean 151.8 mL, SD 127, vs 278 mL, SD 231; p less than 0.001). It also had a shorter postoperative hospital stay (mean 8.2 days, SD 3.7, vs 9.9 days, SD 3.1; p = 0.002).
  • The thoracotomy and uniportal VATS groups did not differ significantly in operative time (223.9 vs 216.1 minutes, p = 0.153), postoperative drainage volume (878.2 vs 885.7 mL, p = 0.140), or short-term radiographic recovery.
  • Across all patients, CT scans 6 months after surgery showed significant changes in all four chest diameters. On the affected side, the transverse diameter went from 9.5 to 10.5 cm and the anteroposterior diameter from 12.8 to 14.2 cm (both p less than 0.001).
  • All 112 patients completed 12 months of follow-up. Overall, 58 had an excellent outcome, 45 a good outcome and 9 a fair outcome, an excellent/good rate of 91.9%.
  • Complications occurred in 19 of 112 patients (17.0%). Six had a prolonged air leak lasting more than 2 weeks, six a loculated pleural effusion needing drainage, and seven delayed wound healing from incision infection. No patient needed reoperation for recurrence and no deaths occurred during follow-up.
  • In an exploratory analysis, patients whose total chest diameter change was under 2 cm (n = 37) were older (mean 42.6 years) than those with 2 cm or more (n = 75; mean 33.3 years), p = 0.001. Surgical method did not differ significantly between these two groups (p = 0.549).
• The authors' conclusion: The authors concluded that uniportal VATS was associated with favourable perioperative outcomes and comparable short-term radiographic recovery. They said the findings are observational associations rather than evidence of superiority, should be interpreted cautiously, and need confirmation in prospective studies with longer follow-up.
• Limitations the authors state:
  • The study was retrospective and single-centre, and the choice of surgery largely reflected a change in hospital practice over time. Confounding from time trends, perioperative care and growing surgical experience cannot be excluded.
  • Pulmonary function data, a more direct measure of recovery, were incomplete, so CT measurements were used only as supportive indicators.
  • The 2-cm cut-off used to split patients by chest expansion was chosen from this dataset for exploratory purposes and was not prespecified or validated.
  • Follow-up lasted only 12 months, so longer-term recurrence, residual chest deformity and functional outcomes were not fully assessed.

Topics

Medical terms in this study, explained in our Lexicon: Thoracic Surgery, Thoracotomy, Empyema, Video-Assisted Thoracoscopic Surgery (VATS), Pleural Plaques.

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