Tehran University of Medical Sciences (TUMS) Academic Journal of Surgery 2423-3218 8 2 2025 08 24 39 43 EN Fariborz Rousta Department of Cardiovascular Surgery, Sina Hospital, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran Majid Montazer Department of Cardiothoracic Surgery, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran Amin Barghan Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran Hadi Amirhooshangi Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran Seid Hadi Saghaleini Department of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran Mahta ZareDini Department of Cardiothoracic Surgery, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran 2025 02 25 Background: Pleural empyema can be fatal and requires surgery if untreated. Stage III empyema, marked by thickened pleura, necessitates surgical intervention. Both open thoracotomy (OT) and video-assisted thoracoscopic surgery (VATS) are viable options, but there is insufficient clinical evidence to determine which is superior. Objective: This study evaluated the preoperative outcomes of VATS and OT in patients with stage III empyema Methods: There were two groups of 30 patients with stage III empyema treated with OT or VATS. We measured patients' preoperative characteristics and analyzed them using t-tests and chi-square tests Results: No difference was seen between the mean (± SD) age of the OT (40.38 ± 19.71) and VATS group (43.56 ± 19.82) (p-value = 0.796). The OT group's surgery and hospital stay (2.15 ± 0.58 hours) was about 1.5 times the VATS procedure (1.44 ± 0.37 hours) (p-value = 0.018). Tachypnea duration (p-value = 0.174) and chest tube duration (p-value = 0.417) were statistically similar between groups. OT patients experienced longer air leaks than VATS patients (p-value = 0.019). Conclusions: Both procedures are effective, but VATS may be preferable due to shorter operation times, hospital stays, and its minimally invasive nature. Further clinical trials are needed for clearer guidance. https://ajs.tums.ac.ir/index.php/ajs/article/view/303