Role of MIS Approaches in Thoracic Emergencies and Trauma

Abstract

There has been an increasing use of minimally invasive techniques to address issues in trauma and acute care surgery. Thoracoscopy or video-assisted thoracoscopic surgery (VATS) is a minimally invasive surgical technique that utilizes port placement in the intercostal spaces and can avoid the painful, large thoracotomy incision. Studies have associated thoracoscopy or VATS with increased patient satisfaction, decreased postoperative pain or pneumonia rates, shorter hospital stays, and even a mortality benefit. There are increasing application for thoracoscopy or VATS techniques within trauma and acute care surgery. Thoracoscopic pleurodesis is often the preferred treatment for spontaneous pneumothorax. A left-sided thoracoscopic pericardial window can also be used to address a pericardial effusions. Retained hemothoraces after thoracic trauma is another common indication for thoracoscopy. It is a minimally invasive technique that can be used to prevent the many complications that are associated with undrained blood in the pleural space. Although laparoscopy is often utilized to evaluate for diaphragm injury in penetrating thoracoabdominal trauma, thoracoscopy is also a useful option. It is often chosen when there is concomitant thoracic injury that requires surgical intervention. Although there are many uses for thoracoscopy, there are limitations to its use as well. Nearly all thoracoscopic procedures require single-lung ventilation. Some patients are unable to tolerate thoracoscopy due to hemodynamic instability or their comorbid conditions. However, with increased experience and use, trauma and acute care surgeons can become facile with the use of thoracoscopy in trauma and acute care surgery.