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Best timing for thoracoscopic evacuation of retained post-traumatic hemothorax

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To determine the best timing for thoracoscopic drainage of clotted hemothorax in order to ensure safe and effective results and to identify risk factors associated with drainage failure.

Materials and methods

Cohort retrospective study of 139 consecutive patients who underwent thoracoscopic retained hemothorax drainage between April 1997 and May 2005.


The procedure was successful in 102 patients (73.4%), in whom complete evacuation was achieved, with no accumulation of fluid in the pleural cavity requiring reintervention. Conversion to thoracotomy was required in 22 patients (15.8%) because of the inability to attain adequate drainage of clots and collections and lung re-expansion. Fifteen patients (10.8%) required reintervention as a result of fluid accumulation in the pleural cavity and lung collapse, and thoracotomy was performed in all those cases. The best results were obtained when thoracoscopic drainage was performed before the fifth day. There were 33 major post-operative complications including 20 cases of empyema of which 10 required thoracotomy, and 13 bronchopleural leaks, four of which required open surgery. There were no fatal outcomes in the study group.


Videothoracoscopy must be considered the procedure of choice for the treatment of retained post-traumatic hemothorax. It is a safe and effective procedure allowing the successful treatment of up to 73.4% of patients. Best results are obtained when drainage is performed within the first five days after trauma.

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  1. Jackson AM, Ferreira AA (1976) Thoracoscopy as an aid to the diagnosis of diaphragmatic injury in penetrating wounds of the lower chest: a preliminary report. Injury 7: 213–217

    Article  PubMed  CAS  Google Scholar 

  2. Milfield DJ, Mattox KL, Beall AC Jr. (1978) Early evacuation of clotted hemothorax. Am J Surg 136: 686–692

    Article  Google Scholar 

  3. Jones JW, Kitahama A, Webb WR, McSwain N (1981) Emergency thoracoscopy: a logical approach to chest trauma management. J Trauma 21: 280–284

    PubMed  CAS  Google Scholar 

  4. Coselli JS, Mattox KL, Beall AC (1984) Reevaluation of early evacuation of clotted hemothorax. Am J Surg 148: 786–790

    Article  PubMed  CAS  Google Scholar 

  5. Eddy AC, Luna GK, Copaus M (1989) Empiema thoracis in patients undergoing emergent closed tube thoracostomy for thoracic trauma. Am J Surg 157: 494–497

    Article  PubMed  CAS  Google Scholar 

  6. Helling TS, Gyles NR III, Eisenstein CL, Soracco CA (1989) Complications following blunt and penetrating injuries in 216 victims of chest trauma requiring tube thoracotomy. J Trauma 29: 1.367–1.370

    Google Scholar 

  7. Mancini M, Smith LM, Nein A, Buechter KJ (1993) Early evacuation of clotted blood in hemothorax using thoracoscopy. Case reports. J Trauma 1993; 34: 144–147

    CAS  Google Scholar 

  8. O’Brien J, Cohen M, Solit R, Lindenbaum G, Finnegan J, Vemick J (1994) Thoracoscopic drainage and decortication as definite treatment for empyema thoracis following penetrating chest injury. J Trauma 36: 536–539

    Article  PubMed  CAS  Google Scholar 

  9. Uribe RA, Pachon CE, Frame SB, Enderson BL, Escobar F, Garcia GA. (1994) A prospective evaluation of thoracoscopy for the diagnosis of penetrating thoracoabdominal trauma. J Trauma 37: 650–654

    PubMed  CAS  Google Scholar 

  10. Villegas MI, Morales CH, Rodríguez JC, Jaramillo JR (1994) Tratamiento por toracoscopia del hemotórax coagulado postraumático. Panam J Trauma 1994; 4: 19–23

    Google Scholar 

  11. Landrenau RJ, Keenan RJ, Hazelrigg SR, Mack MJ, Naunheim KS (1996) Thoracoscopy for empyema and hemothorax. Chest 109:18–24

    Google Scholar 

  12. Wong MS, Tsoi EK, Henderson VJ, Hirvela ER, Forest CT, Smith RS, Fry WR, Organ CH (1996) Videothoracoscopy: an effective method for evaluating and managing thoracic trauma patients. Surg Endosc 10: 118–121

    Article  PubMed  CAS  Google Scholar 

  13. Morales CH, Salinas CM, Henao CA, Patiño PA, Muñoz CM (1997) Thoracoscopic pericardial window and penetrating cardiac trauma. J Trauma 42: 273–275

    PubMed  CAS  Google Scholar 

  14. Heniford BT, Carrillo EH, Spain DA, Sosa JL, Fulton RB, Richardson JD (1997) The role of thoracoscopy in the management of retained thoracic collections after trauma. Ann Thorac Surg 63: 940–943

    Article  PubMed  CAS  Google Scholar 

  15. Abolhoda A, Livingston DH, Donahoo JS, Allen K (1997) Diagnostic and therapeutic video-assisted thoracic surgery (VATS) following chest trauma. Eur J Cardio-thorac Surg 12: 356–360

    Article  CAS  Google Scholar 

  16. Lang-Lazdunski L, Mouroux J, Pons F, Grosdidier G, Martinod E, Elkaim D, Azorin J, Jancovici R (1997) Role of videothoracoscopy chest trauma. Ann Thoracic Surg 63: 327–333

    Article  CAS  Google Scholar 

  17. Liu DW, Liu HP, Lin PJ, Chang CH (1997) Video-assisted thoracic surgery in treatment of chest trauma. J Trauma 42: 670–674

    Article  PubMed  CAS  Google Scholar 

  18. Carrillo EH, Schmacht DC, Gable DR, Spain DA. Richardson JD (1998) Thoracoscopy in the management of posttraumatic persistent pneumothorax. J Am Coll Surg 186: 636–639

    Article  PubMed  CAS  Google Scholar 

  19. Sosa JL, Pombo H, Puente I, Sleeman D, Ginzburg E, McKinney M, Martin L (1998) Thoracoscopy in the evaluation and management of thoracic trauma. Int Surg 83: 187–189

    PubMed  CAS  Google Scholar 

  20. Brasov PG, Kuritsyn AN, Urazovsky NY, Tariverdiev ML (1998) Operative videothoracoscopy in the surgical treatment of penetrating firearms wounds of the chest. Mil Med 163: 603–607

    Google Scholar 

  21. Villavicencio RT, Aucar JA, Wall Jr MJ (1999) Analysis of thoracoscopy in trauma. Surg Endosc 13: 3–9

    Article  PubMed  CAS  Google Scholar 

  22. Velmahos GC, Demetriades D (1999) Early thoracoscopy for the evacuation of undrained haemothorax. Eur J Surg 165: 924–929

    Article  PubMed  CAS  Google Scholar 

  23. Velmahos GC, Demetriades D, Chan L, Tastevossian R, Cornwell EE 3rd, Yassa N, Murray JA, Asensio JA, Berne TV (1999) Predicting the need for thoracoscopic evacuation of residual traumatic hemothorax: Chest radiograph is insufficient. J Trauma 46: 65–70

    PubMed  CAS  Google Scholar 

  24. Villegas MI, Morales CH (2000) Tratamiento del hemotórax coagulado mediante toracoscopia. Rev Colomb Cir 1: 29–31

    Google Scholar 

  25. Morales CH, Villegas MI, Angel W, Vasquez JJ (2001) Value of digital exploration for diagnosing injuries to the left side of the diaphragm caused by stab wounds. Arch Surg 136:1131–1135

    Article  PubMed  CAS  Google Scholar 

  26. Vassiliu P, Velmahos GC, Toutouzas KG (2001). Timing, safety and efficacy of thoracoscopic evacuation of undrained post-traumatic hemothorax. Am Surg 67: 1.165–1.169

    Google Scholar 

  27. Ambrogi MC, Lucchi M, Dini P, Mussi A, Angeletti CA (2002) Videothoracoscopy for evaluation and treatment of hemithorax. J Cardiovasc Surg 43: 109–112

    CAS  Google Scholar 

  28. Pons F, Lang-Lazdunski L, de Kerengal X, Chapuis O, Bonnet PM, Jancovici R (2002) The role of videothoracoscopy in management of precordial thoracic penetrating injuries. Eur J Cardiothorac Surg 22: 7–12

    Article  PubMed  CAS  Google Scholar 

  29. Navsaria PH, Vogel RJ, Nicol AJ (2004) Thoracoscopic evacuation of retained post-traumatic hemothorax. Ann Thorac Surg 78: 282–286

    Article  PubMed  Google Scholar 

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Correspondence to Carlos H. Morales Uribe.

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Morales Uribe, C.H., Villegas Lanau, M.I. & Petro Sánchez, R.D. Best timing for thoracoscopic evacuation of retained post-traumatic hemothorax. Surg Endosc 22, 91–95 (2008).

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