Hackensack University Medical Center Relieves Post-Pneumonia Empyema with Hydrodissection

Thorough scar tissue removal and minimal blood loss in single-incision, camera-guided procedure

Hydrodissection offers an effective, less invasive approach to surgical dissection for empyema, and has become the primary approach used at Hackensack University Medical Center.

In post-pneumonia empyema, draining the fluid is typically the first line. But some of the fluid can gelatinize and eventually become scar tissue. When scar tissue prevents the lungs from fully ventilating, removal is required. This tends to result in significant blood loss and extensive recovery time.

Surgical resection is often performed via a thoracoscopy and can be extremely challenging for the surgeon.

“It tends to be difficult to work in spaces that are small with gelatinous material, which prevents us from seeing much,” Nabil Rizk, M.D., chief of Thoracic Surgery at Hackensack University Medical Center, said.

Hackensack University Medical Center’s thoracic surgery team is taking a novel approach with significant advantages. Dr. Rizk explains the hydrodissection alternative requires one small incision, through which a camera is guided into the gelatinous, infected material providing a view of the scar tissue.

Saline or sterile water is then pumped into the cavity around the lung under pressure to remove the scar tissue instead of mechanically dissecting it. This pressurized treatment may be performed up to six times to flush out scar tissue and infected gelatinized material and fluid.

The hydrodissection approach is thorough, reaches difficult-to-access locations, causes very little bleeding and is less traumatic for patients, Dr. Rizk said.

He said he is not aware of any other centers using hydrodissection in this manner, which was initiated at Hackensack University Medical Center by thoracic surgeons Geoffrey Pels, M.D., and since retired Nazly Shariati, M.D. Given the significant patient and surgeon benefits their team has realized, it is the primary approach they now use for empyema following pneumonia.

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