Video-assisted Thoracoscopic surgery (VATS) in the Management of Haemodynamically Stable Penetrating Chest Trauma
Aksha Ramaesh, Elaine Teh, Douglas West.
University Hospitals Bristol, Bristol, United Kingdom.
OBJECTIVE: Penetrating chest trauma as a result of assault is becoming more prevalent in the UK. In haemodynamically unstable patients, thoracotomy is the standard approach. However, very little data is available for the use of video-assisted thorascopic surgery (VATS) in haemodynamically stable patients.
METHODS: This was a retrospective review of haemodynamically stable patients with penetrating chest trauma transferred to thoracic surgery from January 2013 - June 2019. Data was collected from the Trauma and Audit Research Network (TARN), and hospital electronic records. Simple descriptive analysis was carried out.
RESULTS: 22 cases were identified, with 4 patients admitted from self-inflicted injuries. There were 6 patients with an Injury Severity Score greater than 15. CT scan findings on admission are illustrated in Figure 1. 10 patients had VATS, 2 patients had an emergency thoracotomy, and 10 patients were managed conservatively with intercostal chest drain only. VATS procedures included diaphragmatic repair, washout of haemothorax and empyema, and foreign object removal. Post-operative outcomes are shown in Table 1. At 6-week follow up, 2 patients had persisting CXR pathology, which resolved by week 12. Of the patients with self-inflicted injuries, 1 patient had another episode of deliberate self-harm.
CONCLUSIONS: In patients with penetrating chest trauma but haemodynamically stable, VATS seems to be a reasonable and safe approach with satisfactory outcomes, even in the event of diaphragmatic rupture. It is important to be aware of other needs, such as psychological support, that this group of patients may require prior to discharge.
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