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Thoracoscopic debridement for acute empyema was successfully performed in three patients who were refractory to closed drainage, irrigation and antibiotic therapy. In two patients anaerobic organisms were isolated from the pus. None of the patients had bronchopleural fistula. All patients were relieved of fever promptly after surgery. Operative invasion was minimal, and postoperative lung function was well maintained one month after the operation. If empyema is in the fibrinopurulent phase and does not respond to pleural drainage, thoracoscopic debridement may be indicated before more aggressive therapy.
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