Videothoracoscopic evaluation of thoracic injuries

Abstract

Residual thoracic collections after thoracic traumas occur in 5-30% of patients and are a major risk factor for development of empyema. Management with a thoracostomy tube is the traditional treatment but it requires a prolonged hospital stay and 20% of patients treated continue to have a residual clot. Forty-two haemodynamically stable patients with chest trauma (36 blunt and 6 penetrating) were examined thoracoscopically. Indications for videothoracoscopy included suspected diaphragmatic injury (8 patients), persistent pneumothorax (8), continued haemorrhage (6) and clotted haemothorax (20). Diaphragmatic lacerations were confirmed thoracoscopically in 7 patients. Four of them were successfully repaired with thoracoscopic techniques and three were repaired after conversion to open thoracotomy for large diaphragmatic lacerations. In patients with persistent pneumothorax, limited lung lacerations were correctly diagnosed and repaired thoracoscopically. In all patients with continued haemorrhage intercostal artery injury was confirmed and repaired by diathermy. All clotted haemothorax cases were successfully evacuated. No complications occurred. Videothoracoscopy appears to be a safe, accurate and reliable operative therapy for the assessment of diaphragmatic injuries, control of continued bleeding and evacuation of clotted haemothorax, reducing the hospital stay and possible complications.