To determine whether a new surgical method using a flexible endoscope (FlexVATS) to perform sparing debridement and apply negative-pressure therapy without extensive decortication may be an alternative treatment option for empyema.

Surgical treatment of pleural empyema is associated with considerable postoperative complications and mortality rates, and alternative treatment options are being explored to improve patient outcomes. This was a prospective case series.

17 consecutive patients treated with FlexVATS between February 2021 and August 2022 were included in the study.

Only patients for whom FlexVATS was the first therapeutic intervention for pleural empyema were included.

Treatment success, defined as infection resolution, was the primary endpoint of the study.

The secondary endpoints were length of hospital stay, 90-day mortality, and empyema cavity volume reduction. Patients who had previously been treated for pleural empyema by either drainage or surgery were excluded.

The trial was performed as a single-centre study at a tertiary medical centre in Germany.

In total, 17 patients with pleural empyema were included in the study.

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