Video-Assisted Thoracic Surgery as a Less-Invasive Management for Acute Hemothorax in Blunt Trauma

Yoshihiko Kurimoto, Atsushi Watanabe, Tetsuya Koyanagi, Toshiro Ito, Tetsuya Higami, Kunihiko Maekawa, Katsutoshi Tanno, Yasufumi Asai

Department of Thoracic and Cardiovascular, Surgery Sapporo Medical University, Sapporo, Japan.
Department of Traumatology and Critical Care Medicine, Sapporo Medical University, Sapporo, Japan.

DOI: 10.4236/ss.2012.33027                

Abstract

Purpose: We report our experience of Video-assisted thoracic surgery (VATS) to treat acute blunt traumatic hemothorax using mini-thoracotomy. Methods: We designed a prospective study to determine if VATS with mini-thoracotomy benefits for patients with blunt traumatic hemothorax compared with conventional repair through full thoracotomy. Twenty-five patients underwent emergency operation for acute hemothorax from 2000. Five patients with less than 5% probability of survival (PS) were excluded, leaving 20 as the subjects. Results: Ten patients underwent conventional thoracotomy (conventional group) and the other 10 patients underwent VATS with mini-thoracotomy (VATS group). There was no difference between conventional group and VATS group in injury severity score (29.1 and 27.0) or PS (81.2% and 80.7%). Hospital mortality rates were 10% in conventional group and 0% in VATS group (N.S). Total amounts of intra-operative bleeding and post-operative transfusion until day 7 were 735 ml and 19.3 units in conventional group and 303 ml and 9.2 units in VATS group respectively (N.S). The length of ICU stay was 9.7 days in conventional group and 5.9 days in VATS group (N.S). Conclusion: VATS with mini-thoracotomy can be alternative for patients with blunt traumatic hemothorax in most emergency operations.

Keywords

Hemothorax; Trauma; Video-Assisted Thoracic Surgery; Emergency Surgery; Critical Care

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	M. G. Ochsner, G. S. Rozycki, F. Lucente, D. C. Wherry and H. R. Champion, “Prospective Evaluation of Thoracoscopy for Diagnosing Diaphragmatic Injury in Thoracoabdominal Trauma: A Preliminary Report,” Journal of Trauma, Vol. 34, No. 5, 1993, pp. 704-709. doi:10.1097/00005373-199305000-00013
[2]	N. Ahmed and D. Jones, “Video-Assisted Thoracic Surgery: State of the Art in Trauma Care,” Injury, Vol. 35, No. 5, 2004, pp. 479-489. doi:10.1016/S0020-1383(03)00289-4
[3]	A. V. Manlulu, T. W. Lee, K. H. Thung, R. Wong and A. P. Yim, “Current Indications and Results of VATS in the Evaluation and Management of Hemodynamically Stable Thoracic Injuries,” European Journal of Cardio-Thoracic Surgery, Vol. 25, No. 6, 2004, pp. 1048-1053. doi:10.1016/j.ejcts.2004.02.017
[4]	C. R. Boyd, M. A. Tolson and W. S. Copes, “Evaluating Trauma Care: The TRISS Method. Trauma Score and the Injury Severity Score,” Journal of Trauma, Vol. 27, No. 4, 1987, pp. 370-378. doi:10.1097/00005373-198704000-00005
[5]	K. L. Mattox, M. J. Wall and L. R. Pickard, “Thoracic Trauma,” In: D. Feliciano, E. Moore and K. L. Mattox, Eds., Trauma, 3rd Edition, Appleton & Lang, Stanford, 1996, pp. 345-354.
[6]	E. H. Carrillo, B. T. Heniford, S. W. Etoch, H. C. Polk Jr., D. L. Miller, F. B. Miller and J. D. Richardson, “Video-Assisted Thoracic Surgery in Trauma Patients,” Journal of American College of Surgery, Vol. 184, No. 3, 1997, pp. 316-324.
[7]	E. H. Carrillo and J. D. Richardson, “Thoracoscopy for the Acutely Injured Patient,” American Journal of Surgery, Vol. 190, No. 2, 2005, pp. 234-238. doi:10.1016/j.amjsurg.2005.05.018
[8]	L. Lang-Lazdunski, J. Mouroux, F. Pons, G. Grosdidier, E. Martinod, D. Elka?m, J. Azorin and R. Jancovici, “Role of Videothoracoscopy in Chest Trauma,” Annals of Thoracic Surgery, Vol. 63, No. 2, 1997, pp. 327-333. doi:10.1016/S0003-4975(96)00960-5
[9]	J. A. Kern, C. G. Tribble, W. D. Spotnitz, B. M. Rodgers and T. M. Daniel, “Thoracoscopy in the Subacute Management of Patients with Thoracoabdominal Trauma,” Chest, Vol. 104, No. 3, 1993, pp. 942-945. doi:10.1378/chest.104.3.942
[10]	P. H. Navsaria, R. J. Vogel and A. J. Nicol, “Thoracoscopic Evaluation of Retained Posttraumatic Hemothorax,” Annals of Thoracic Surgery, Vol. 78, No. 1, 2004, pp. 282-286. doi:10.1016/j.athoracsur.2003.11.029
[11]	M. Martinez, J. E. Briz and E. H. Carillo, “Video Thoracoscopy Expedites the Diagnosis and Treatment of Penetrating Diaphragmatic Injuries,” Surgical Endoscopy, Vol. 15, No. 1, 2001, pp. 28-32. doi:10.1007/s004640002090
[12]	D. J. Milfeld, K. L. Mattox and A. C. Beal Jr., “Early Evacuation of Clotted Hemothorax,” American Journal of Surgery, Vol. 136, No. 6, 1978, pp. 686-692. doi:10.1016/0002-9610(78)90336-7
[13]	J. A. Murray, D. Demetriades, J. A. Asensio, E. E. Cornwell 3rd, G. C. Velmahos, H. Belzberg and T. V. Berne, “Occult Injuries to the Diaphragm: Prospective Evaluation of Laparoscopy in Penetrating Injuries to the Left Chest,” Journal of American College of Surgery, Vol. 187, No. 6, 1998, pp. 626-630. doi:10.1016/S1072-7515(98)00246-4
[14]	R. K. Freeman, G. Al-Dossari, K. A. Hutcheson, L. Huber, M. E. Jessen, D. M. Meyer, M. A. Wait and J. M. DiMaio, “Indications for Using Video-Assisted Thoracoscopic Surgery to Diagnose Diaphragmatic Injuries after Penetrating Chest Trauma,” Annals of Thoracic Surgery, Vol. 72, No. 2, 2001, pp. 342-347. doi:10.1016/S0003-4975(01)02803-X
[15]	C. W. Hsiao, S. C. Lee, C. Tzao, J. C. Chen and Y. L. Cheng, “Minithoracotomy with Simultaneous Video-Assisted Thoracoscopic Surgery vs Video-Assisted Thoracoscopic Surgery for Spontaneous Hemopneumothorax,” Thoracic Cardiovascular Surgery, Vol. 51, No. 5, 2003, pp. 288-290. doi:10.1055/s-2003-43077