Role of video-assisted thoracic surgery in the evaluation and management of thoracic injuries

Abstract

The aim of this study was to evaluate the experience of our institution with the use of video-assisted thoracic surgery (VATS) in chest trauma. Between January 1999 and September 2004, 25,213 patients presented with chest trauma to the emergency room, and 2304 were admitted to our service. Twenty-three hemodynamically stable patients (1%) underwent VATS. They were 19 men and 4 women with an average age of 42 years (range, 19-67 years). Indications included post-traumatic hemothorax in 11 patients, and post-traumatic empyema in 3, treated after 24 h of trauma. Indications for exploratory VATS in the acute phase included suspected diaphragmatic injury in 3 patients, persistent pneumothorax in 2, continued hemorrhage in 2 and removal of intrathoracic foreign body in 2. There was no mortality and complications occurred in 3 patients (13%). Management of hemodynamically stable thoracic injuries by using VATS provides diagnostic accuracy and therapeutic efficacy. It can be successfully applied in the trauma setting and surgeons should gain experience with its use.

Experiences of Video-assisted Thoracic Surgery in Trauma

“…VATS can provide complete visualization of intrathoracic organs including diaphragm, pericardium and mediastinum [5][6][7]. Therefore, VATS was mainly used for evacuation of retained hemothorax, wedge resection of lung, decortication of empyema and repair of diaphragm [5,6,10,11]. Our results were similar to the previous reports: operative procedures included evacuation of clotted hemothorax (3 cases), wedge resection (3 cases), adhesiolysis and decortication (2 cases), hemostasis of intrathoracic bleeders (1 case), repair of diaphragm (1 case) and suture repair of the lacerated lung (1 case).…”

Videotoracoscopia para remoção de corpo estranho da cavidade pleural

“…Some researchers (3,5) believe that the ease and practicality of video-assisted thoracoscopy, as compared with thoracotomy, should not be used as the principal argument in favor of the removal of intrathoracic bullets.…”

“…In the late phase, usually, the irritation process causes fibrous adherences that have the end result of lodging the foreign body in the point of greatest declination. (4,5) In our two patients, the X-rays were taken in the acute phase, when the bullets were still free in the pleural cavity. In Case 2, the bullet was thought to be located in the abdomen.…”

“…However, the removal is necessary in cases of nonmetallic foreign bodies, as well as in cases of large metallic objects or objects with sharp edges. (2,3,5) In asymptomatic and symptomatic patients alike, if the steel wires or pins used for osteosynthesis have migrated to the interior of the chest, surgical removal is mandatory. Since these are sharp objects, there is a risk that they will erode or perforate the organs and adjacent structures.…”

Cardiac and Pulmonary Injury

“…There was no mortality and complications occurred in three patients (13%). Potaris et al [45] concluded that VATS provides diagnostic accuracy and therapeutic efficacy in hemodynamically stable patients with thoracic injuries.…”