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Video-assisted thoracoscopy as an important tool for trauma surgeons: a systematic review

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Abstract

Purpose

Trauma patients frequently have serious chest injuries. Retained hemothoraces and persistent pneumothoraces are among the most frequent complications of chest injuries which may lead to major, long-term morbidity and mortality if these complications are not recognized and treated appropriately. Video-assisted thoracoscopy (VATS) is a well-established technique in surgical practice. The usefulness of VATS for treatment of complications after chest trauma has been demonstrated by several authors. However, there is an ongoing debate about the optimal timing of VATS.

Methods

A computerized search was conducted which yielded 450 studies reporting on the use of VATS for thoracic trauma. Eighteen of these studies were deemed relevant for this review. The quality of these studies was assessed using a check-list and the PRISMA guidelines. Outcome parameters were successful evacuation of the retained hemothorax or treatment of other complications as well as reduction of empyema rate, length of hospital stay, and hospital costs.

Results

There was only one randomized trial and two prospective studies. Most studies report case series of institutional experiences. VATS was found to be very successful in evacuation of retained hemothoraces and seems to reduce the empyema rate subsequently. Furthermore, the length of hospital stay and costs can be drastically reduced with the early use of VATS.

Conclusion

Early VATS is an effective treatment for retained hemothoraces or other complications of chest trauma. We propose a clinical pathway, in which VATS is used as an early intervention in order to prevent serious complications such as empyemas or trapped lung.

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Acknowledgments

Dr. Billeter holds the Joint Royal College of Surgeons of Edinburgh (RCSEd)/James and Emmeline Ferguson Research Fellowship. This work was funded in part by the Price Trust Fund and by the Joint Royal College of Surgeons of Edinburgh (RCSEd)/James and Emmeline Ferguson Research Fellowship Trust. The funding source had no role in the production of the manuscript.

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Authors and Affiliations

  1. Hiram C. Polk Jr. M.D. Department of Surgery and Price Institute of Surgical Research, University of Louisville School of Medicine, Louisville, KY, 40292, USA

    Adrian T. Billeter, Devin Druen, Glen A. Franklin, Jason W. Smith, William Wrightson & J. David Richardson

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  1. Adrian T. Billeter
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  2. Devin Druen
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  3. Glen A. Franklin
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Corresponding author

Correspondence to Glen A. Franklin.

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Billeter, A.T., Druen, D., Franklin, G.A. et al. Video-assisted thoracoscopy as an important tool for trauma surgeons: a systematic review. Langenbecks Arch Surg 398, 515–523 (2013). https://doi.org/10.1007/s00423-012-1016-7

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  • DOI: https://doi.org/10.1007/s00423-012-1016-7

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