Uniportal video-assisted thoracoscopic surgery in hemothorax

Abstract

The management of hemothorax (spontaneous or, more often, due to thoracic trauma lesions), follows basic tenets well-respected by cardiothoracic surgeons. In most, a non-operative approach is adequate and safe, with a defined group of patients requiring only tube thoracostomy. Only a minority of patients need a surgical intervention due to retained hemothorax, persistent bleeding or incoming complications, as pleural empyema or entrapped lung. In the early 1990s, the rapid technological developments determined an increase of diagnostic and therapeutical indications for multiport video-assisted thoracoscopic surgery (VATS) as the gold standard therapy for retained and persistent hemothorax, allowing an earlier diagnosis, total clots removal and better tubes placement with less morbidity, reduced post-operative pain and shorter hospital stay. There is no consensus in the literature regarding the timing for draining hemothorax, but best results are obtained when the drainage is performed within the first 5 days after the onset. The traditional multiport approach has evolved in the last years into an uniportal approach that mimics open surgical vantage points utilizing a non-rib-spreading single small incision. Currently, in experienced hands, this technique is used for diagnostic and therapeutic interventions as hemothorax evacuation as like as the more complex procedures, such as lobectomies or bronchial sleeve and vascular reconstructions. visualization, a higher yield of detecting small injuries, less post-operative pain, improved lung function, shorter hospital stay and earlier recovery (2,5,7,8). KeywordsMore recently, the uniportal VATS approach has gained popularity in thoracic surgery, initially for minor procedures (9,10) and then also for major lung resection (11,12). This paper summarised recent advances available in the medical literature focusing especially on the VATS treatment of hemothorax, in particular considering the advantages of uniportal versus multiportal approach. Multiportal VATS strategy: basic conceptsThoracoscopy in the last years has been suggested as the first-line treatment in non-complicated hemothorax, leaving thoracotomy as the rescue option in case of failure or major trauma with bleeding (7). Truly, Joao Martins Castello Branco in 1946 was the first to describe the use of thoracoscopy in thoracic trauma, managing persistent bleeding with electrocoagulation. Since then, many authors described the use of this technique for diagnostic (diaphragmatic lesions) and therapeutic (hemothorax in penetrating chest trauma) options (13,14). However, only in the late 1990s, due to technical advances, its use became worldwide popular and VATS gained a primary position in the care of thoracic trauma patients (7,15). Villavicencio et al. (16) demonstrated that thoracoscopy may be used safely and successfully in assessment of clotted or persistent hemothorax and in empyema drainage; according to their data, 90-95% of patients with posttraumatic hemothorax are treated conservatively o...

Efficacy of uniportal video assisted thoracoscopic surgery in management of primary spontaneous hemopneumothorax

“…Thoracotomy and decortication of the lung was the first surgical treatment, which was performed by Elrod and Murphy in a patient 6 weeks after the onset of PSHP [8]. VATS has now become the initial and the gold standard treatment for spontaneous hemopneumothorax, especially for patients with active hemorrhage and massive blood clot in the thorax [5]. This kind of procedure leads to less postoperative pain and shorter hospital stay unlike the open thoracotomy which can cause more pain, poor cosmetic outcome, and possible respiratory impairment [5].…”

“…It is one of surgery indications which can be performed either by a thoracotomy or less invasively by Video-Assisted Thoracoscopic Surgery (VATS) [4]. VATS is now becoming less invasive by performing it through only a single incision (Uniportal VATS) [5] This work has been reported in line with the SCARE criteria [6].…”

Spontaneous hemopneumothorax after laparoscopy: a case report and literature review

“… 16 VATS has now become the most important treatment for SHP, especially for patients with massive blood clots and active hemorrhage in the thoracic cavity. 17 From a diagnostic and therapeutic point of view, VATS seems to be a better choice than thoracotomy. 15 Therefore, VATS rather than conservative chest drainage should be considered immediately after diagnosis of SHP.…”

Traumatic retained hemothorax: is it time for video assisted thoracoscopic surgery

“…Other techniques like uniportal VATS involves using a 1.5 to 2.5 cm incision in the 4th to 6th intercostal space alone posterior axillary line to access the pleural cavity. 21…”