Abstract
Background: The objective of this study was to assess the diagnostic and therapeutic effectiveness of videothoracoscopy in thoracic trauma patients.
Methods: The design was a retrospective review. The setting was a major trauma center at an urban county hospital. Forty-one hemodynamically stable patients sustaining thoracic trauma were reviewed (34 penetrating and 7 blunt injuries). In the acute setting (<24 h), videothoracoscopy was used for continued bleeding (6) and suspected diaphragmatic injury (17). Thoracoscopy was used in delayed settings (>24 h) for treatment of thoracic trauma complications (18) including clotted hemothorax (14), persistent air leak (1), widened mediastinum (1), and suspected diaphragmatic injury (2).
Results: The average Injury Severity Score (ISS) of these patients was 18.9±10.0. Three of 6 patients (50%) with continued bleeding were successfully treated thoracoscopically. Nine of 10 (90%) diaphragmatic injuries were confirmed by thoracoscopy, and 7 of these 9 patients (77%) were repaired thoracoscopically. Thirteen of 14 patients (93%) with clotted hemothoraces and one with a persistent air leak were treated successfully using thoracoscopy. An aortic injury was ruled out in one patient.
Conclusions: Videothoracoscopy is a safe, accurate, minimally invasive, and potentially cost-effective method for the diagnosis and therapeutic management of thoracic trauma patients.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Adamthwaite DN (1984) Diaphragmatic hernia presenting itself as a surgical emergency. Injury 15: 367–369
Branco JMC (1946) Thoracoscopy as a method of exploration in penetrating injuries of the chest. Dis Chest 12: 330–335
Graeber GM, Jones DR (1993) The role of thoracoscopy in thoracic trauma. Ann Thorac Surg 56: 646–648
Haasler GB (1995) Video-assisted thoracic surgery. In: Frantzides CT (ed) Laparoscopic and thoracoscopic surgery. Mosby, St. Louis, pp 253–284
Helling TS, Gyles NR, Eisenstein CL, Soracco CA (1989) Complications following blunt and penetrating injuries in 216 victims of chest trauma requiring tube thoracostomy. J Trauma 29: 1367–1370
Ivatury RR, Simon RJ, Weksler B, Bayard V, Stahl WM (1992) Laparoscopy in the evaluation of the intrathoracic abdomen after penetrating injury. J Trauma 33: 101–109
Jackson AM, Ferreira AA (1976) Thoracoscopy as an aid to the diagnosis of diaphragmatic injury in penetrating wounds of the left lower chest: a preliminary report. Injury 7: 213–217
Jacobaeus HC (1910) Possibility of the use of the cystoscope for investigation of serous cavities. Munch Med Wochenschr 57: 2090–2092
Jones JW, Kitahama A, Webb WR, McSwain N (1981) Emergency thoracoscopy: a logical approach to chest trauma management. J Trauma 21: 280–284
Kaiser LR (1994) Video-assisted thoracic surgery: current state of the art. Ann Surg 220: 720–734
Koehler RH, Smith RS (1994) Thoracoscopic repair of missed diaphragmatic injury in penetrating trauma: case report. J Trauma 36: 424–427
Madden MR, Paull DE, Finkelstein JL, Goodwin CW, Marzulli V, Yurt RW, Shires GT (1989) Occult diaphragmatic injury from stab wounds to the lower chest and abdomen. J Trauma 29: 292–298
Mancini M, Smith LM, Nein A, Buechter KJ (1993) Early evacuation of clotted blood in hemothorax using thoracoscopy: case reports. J Trauma 34: 144–147
O'Brien J, Cohen M, Solit R, Solit R, Lindenbaum G, Finnegan J, Vernick J (1994) Thoracoscopic drainage and decortication as definitive treatment for empyema thoracis following penetrating chest injury. J Trauma 36: 536–540
Ochsner MG, Rozycki GS, Lucente F, Wherry DC, Champion HR (1993) Prospective evaluation of thoracoscopy for diagnosing diaphragmatic injury in thoracoabdominal trauma: a preliminary report. J Trauma 34: 704–710
Pagliarello G, Carter J (1992) Traumatic injury to the diaphragm: timely diagnosis and treatment. J Trauma 33: 194–197
Ridley PD, Braimbridge MV (1991) Thoracoscopic debridement and pleural irrigation in the management of empyema thoracis. Ann Thorac Surg 51: 461–464
Smith RS, Fry WR, Tsoi EKM, Morabito DJ, Koehler RH, Reinganum SJ, Organ CH Jr (1993) Preliminary report on videothoracoscopy in the evaluation and treatment of thoracic injury. Am J Surg 166: 690–695
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
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Wong, M.S., Tsoi, E.K.M., Henderson, V.J. et al. Videothoracoscopy. Surg Endosc 10, 118–121 (1996). https://doi.org/10.1007/BF00188355
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00188355