Videothoracoscopy An effective method for evaluating and managing thoracic trauma patients

Abstract

Videothoracoscopy is a safe, accurate, minimally invasive, and potentially cost-effective method for the diagnosis and therapeutic management of thoracic trauma patients.

Best timing for thoracoscopic evacuation of retained post-traumatic hemothorax

“…Diagnostic and therapeutic indications in trauma have increased with the growing enthusiasm and training of trauma surgeons in endoscopic techniques. Overall, thoracoscopy is indicated in hemodynamically stable patients for the identification and control of continuous bleeding [12], from suspected mediastinal, cardiac [13,28] or diaphragmatic injuries [9,25], evacuation of retained posttraumatic hemothorax [14,10] and the treatment of post-traumatic bronchopleural fistulae [18] and diaphragmatic injuries.…”

Video-assisted thoracoscopy in the early diagnosis and management of post-traumatic pneumothorax and hemothorax

“…An exhaustive review of the North American experience published in 1984 [14], that included a total of 4766 patients treated before the advent of VATS, showed that blood clots persisted in 4% of patients with a 10-day mean hospital stay. More recent reviews showed similar results [17] and have led to an unanimous consensus on the need to perform an accurate pleural cavity lavage. However, there are different views as to how this goal may be achieved, even among those who perform VATS with traditional instruments or a rigid video-thoracoscope [18].…”

Thoracoscopy for Trauma

“…Thoracoscopy has a role in both the diagnosis and treatment of trauma [5][6][7][8][9][10][11]. These indications are likely to expand with increased experience and improvements in instrumentation.…”

“…These patients are at risk for diaphragmatic injury that can effectively be investigated by thoracoscopy, especially if concomitant intraabdominal injury is a remote possibility. Wong et al [9] documented that 9 of 10 (90%) diaphragmatic injuries were confirmed by thoracoscopy. Uribe et al [11] evaluated 28 patients with thoracoabdominal penetrating wounds and identified diaphragmatic injury in 9 (32%) of them.…”

“…Wong et al [9] analyzed 41 patients with thoracic trauma and successfully treated 3 of 6 patients (50%) with continued thoracic bleeding and 7 of 9 with diaphragmatic lacerations. Thirteen of 14 patients (93%) with clotted hemothoraces and one with a persistent air-leak were also managed successfully using thoracoscopy.…”