Innovative Thoracoscopic Management of Empyema Thoracis with Alveolopleural Fistula Using Laparoscopic Instruments in a Peripheral Hospital Setting: A Case Report

A 50-year-old male presented with fever, dyspnea, and right-sided chest pain.Imaging confirmed a loculated right pleural effusion with a collapsed right lung.Diagnostic thoracocentesis and culture grew Klebsiella pneumoniae.The patient showed suboptimal response to initial tube drainage, parenteral antibiotics, and had persistent air leak and a trapped lung.We performed a thoracoscopic adhesiolysis using standard laparoscopic equipment (a 30 10-mm laparoscope, an atraumatic upper curved fenestrated bowel grasper, a laparoscopic alligator grasper, a laparoscopic suction irrigation cannula, and monopolar cautery) in a peripheral army hospital lacking thoracoscopy-specific instruments.Thick septations and pus were evacuated, and an alveolopleural fistula (APF) was identified.An autologous blood patch (100 mL of the patient's venous blood) was injected via the laparoscope under vision.Postoperatively, the lung expanded completely, the chest tube was removed on day 7, and the patient recovered uneventfully.The use of laparoscopic instruments for thoracic intervention has rarely been described in resource-limited settings.Our experience suggests this approach is feasible and safe for thoracoscopic adhesiolysis, with shorter hospital stay and recovery comparable to prolonged antibiotics and intercostal drain (ICD) drainage (only available option in peripheral settings).This innovation can extend minimally invasive care to resource-limited hospitals, but requires appropriate preprocedure risk assessment, training, and support.