PURPOSE: Operative intervention for thoracic trauma typically requires thoracotomy. The role of video-assisted thoracoscopic surgery (VATS) continues to broaden with recent application in major elective thoracic procedures. VATS has been applied to non-emergent therapy of certain complications of thoracic trauma. We hypothesized that VATS may be safely and effectively utilized for emergent management of select thoracic traumatic injuries.
METHODS: The Trauma Registry Database of a level one trauma center at a university hospital was queried from 1992 through 2005 for all VATS CPT codes. Emergency department records, operative reports, and discharge summaries were also reviewed to identify the patients who underwent VATS within 24 hours of admission.
RESULTS: Sixteen patients underwent VATS within 24 hours of admission: one (6%) following blunt injury and 15 (94%) after penetrating trauma. All were hemodynamically stable at the time of operation. Fifteen (94%) were males. Average age was 27 years (range 18-51). Indications for emergent VATS were: six evaluations for diaphragmatic injury (38%), five retained hemothoraces (31%), three ongoing hemorrhages (19%), one open pneumothorax (6%), and one pneumomediastinum (6%). Interventions were performed in 12 (75%): eight hemothorax evacuations (50%), five pulmonary parenchymal repairs (31%), two diaphragmatic repairs (12%), and one stab wound cauterization (6%). Four (25%) underwent diagnostic VATS. No conversions to thoracotomy were required. In one patient a diaphragmatic laceration diagnosed by VATS was repaired after splenectomy during laparotomy. No patient required re-operation. Mean postoperative length of stay was 4.3 days (range 2-12). There were no deaths.
CONCLUSION: VATS is safe and effective for managing acute thoracic trauma in hemodynamically stable patients.
CLINICAL IMPLICATIONS: Video-assisted thoracoscopic surgery (VATS) may be increasingly utilized for emergent management of select thoracic traumatic injuries.
DISCLOSURE: Jaime Lewis, None.