Exploring the principles and surgical techniques of thoracoscopic pleural dissection assisted by three-dimensional reconstruction.

A retrospective analysis was performed on the clinical and surgical data of a patient with encapsulated empyema, who underwent preoperative three-dimensional(3D) reconstruction and thoracoscopic minimally invasive surgery at the Minimally Invasive Treatment Center of Beijing Chest Hospital in Jan. 2022. Imaging findings of lung re-expansion were followed up one year after surgery.

The preoperative 3D reconstruction provided a precise delineation of the empyema′s position and dimensions, enabling the development of tailored surgical incisions. During the surgical procedure, the initial step consisted of utilizing a single operative portal for adhesiolysis, dissociating the lung from the chest wall, pericardium, and diaphragm. Subsequently, a second incision was made at the inferior aspect of the empyema, facilitating the detachment of the thickening pleura from the chest wall and complete resection of the intrathoracic lesion. The patient was extubated five days postoperatively and discharged seven days later, without encountering any significant complications. The histopathological examination revealed tuberculous encapsulated empyema. One year after surgery, a chest CT scan demonstrated complete dilation of the lungs, absence of residual cavities or effusions within the thoracic cavity, and symmetrical chest contour. The overall treatment outcome was deemed satisfactory.

Thoracoscopic treatment for encapsulated empyema is safe and feasible. 3D reconstruction helps to develop surgical plans before surgery and evaluate surgical efficacy after surgery. During surgery, the sequence of adhesion separation should be reasonably selected according to the situation and side injuries should be avoided.