Is Video Assisted Thoracoscopy (VATS) Satisfactory Tool for Evacuation of Post-Traumatic Hemothorax?

Objectives: To evaluate the rule and efficacy of thoracoscopy in the management of retained post-traumatic hemothorax, the evaluation includes the feasibility of the procedure, the success rate and the best time for doing it. Patients and Methods: This is a prospective study conducted in 4 tertiary centers in Egypt since August 2006 till January 2016. All patients complained from either blunt or sharp trauma. Patients with incomplete drainage of hemothorax by chest tube underwent thoracoscopic evacuation of the retained hemothorax. VATS procedure was done through three ports which were made along the thoracotomy line for conversion to thoracotomy in case of failure of the VATS procedure. Results: The study included 1226 patients; with isolated unilateral traumatic hemothorax. The cause of hemothorax was blunt trauma in 56% of patients, gunshot in 17% of patients and stab wound in 27% of patients. Total success rate of VATS intervention was 77.1% in all cases. Success rate was 100% for those operated by the 3rd day, 79.9% for those operated by the 4th day, 77.6% for those operated by the 5th day, 57.1% for those operated by the 6th day and 50% for those operated by the 7th day. There was no intraoperative, no postoperative mortality in patients operated thoracoscopically or those converted to open thoracotomy. Conclusion: Thoracoscopic evacuation of post-traumatic hemothorax is not a complicated procedure and carries high success rates if done early.

[1]  M. Elemam,et al.  Chest Trauma: A Tertiary Center Experience , 2017 .

[2]  Z. Brzezinski,et al.  Video-assisted thoracic surgery in hemothorax evacuation after cardiac surgery or cardiac interventions , 2017, Kardiochirurgia i torakochirurgia polska = Polish journal of cardio-thoracic surgery.

[3]  Chyan Yang,et al.  How early should VATS be performed for retained haemothorax in blunt chest trauma? , 2014, Injury.

[4]  Bedir M Ibrahim,et al.  Traumatic intrathoracic tracheobronchial injuries: A study of 78 cases , 2014, Asian cardiovascular & thoracic annals.

[5]  P. Rhee,et al.  Randomized clinical trial of pigtail catheter versus chest tube in injured patients with uncomplicated traumatic pneumothorax , 2014, The British journal of surgery.

[6]  R. McIntyre,et al.  Western Trauma Association critical decisions in trauma: penetrating chest trauma. , 2013, The journal of trauma and acute care surgery.

[7]  N. Soomro,et al.  Thoracoscopic evacuation of retained post-traumatic hemothorax. , 2013, Journal of the College of Physicians and Surgeons--Pakistan : JCPSP.

[8]  S. Broderick.  Hemothorax: Etiology, diagnosis, and management. , 2013, Thoracic surgery clinics.

[9]  T. Pritts,et al.  Video-assisted thoracoscopic surgery for acute thoracic trauma , 2007, Journal of emergencies, trauma, and shock.

[10]  J. Baxa,et al.  Multidetector computed tomography of chest trauma: indications, technique and interpretation , 2012, Insights into Imaging.

[11]  T. Higami,et al.  Video-Assisted Thoracic Surgery as a Less-Invasive Management for Acute Hemothorax in Blunt Trauma , 2012 .

[12]  L. Beenen,et al.  Initial assessment of chest X-ray in thoracic trauma patients: Awareness of specific injuries. , 2012, World journal of radiology.

[13]  K. Inaba,et al.  Management of post-traumatic retained hemothorax: A prospective, observational, multicenter AAST study , 2012, The journal of trauma and acute care surgery.

[14]  M. Melek,et al.  Isolated Hemothorax following Thoracic Trauma: Analysis of 57 Cases , 2012 .

[15]  J. Richardson,et al.  Early VATS for blunt chest trauma: a management technique underutilized by acute care surgeons. , 2011, The Journal of trauma.

[16]  E. Haut,et al.  Practice Management Guidelines for Management of Hemothorax and Occult Pneumothorax Statement of the Problem Level 3 , 2022 .

[17]  Robert I. White,et al.  Hemothorax due to rupture of pulmonary arteriovenous malformation: an interventional emergency. , 2010, Chest.

[18]  Facs Rao R. Ivatury MD.  Thoracoscopy for Trauma , 2010, European Journal of Trauma and Emergency Surgery.

[19]  D. Margulies,et al.  Video-assisted thoracoscopic surgery in the management of penetrating and blunt thoracic trauma , 2009, Journal of minimal access surgery.

[20]  R. Karmy-Jones,et al.  Residual hemothorax after chest tube placement correlates with increased risk of empyema following traumatic injury. , 2008, Canadian respiratory journal.

[21]  C. H. Morales Uribe,et al.  Best timing for thoracoscopic evacuation of retained post-traumatic hemothorax , 2008, Surgical endoscopy.

[22]  J. Richardson,et al.  Role of thoracoscopy in acute management of chest injury , 2006, Current opinion in critical care.

[23]  R. Wong,et al.  Current indications and results of VATS in the evaluation and management of hemodynamically stable thoracic injuries. , 2004, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[24]  Sadi Kaya,et al.  A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management. , 2003, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[25]  K. Naunheim,et al.  Thoracoscopic evaluation and treatment of thoracic trauma. , 2000, The Surgical clinics of North America.

[26]  M. Wait,et al.  Early evacuation of traumatic retained hemothoraces using thoracoscopy: a prospective, randomized trial. , 1997, The Annals of thoracic surgery.

[27]  A. Abolhoda,et al.  Diagnostic and therapeutic video assisted thoracic surgery (VATS) following chest trauma. , 1997, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[28]  J. Mateer,et al.  Trauma Ultrasound Examination Versus Chest Radiography in the Detection of Hemothorax , 1997, Annals of emergency medicine.

[29]  Andro,et al.  Management of retained hemothoraces after chest tube thoracostomy for trauma , 2022 .