Uniportal video-assisted thoracoscopic surgery in hemothorax

Area of Science:

• Thoracic Surgery
• Minimally Invasive Procedures
• Trauma Management

Background:

• Hemothorax management, whether spontaneous or trauma-related, typically involves non-operative approaches or tube thoracostomy.
• Surgical intervention is reserved for specific complications like retained hemothorax, persistent bleeding, or pleural empyema.
• Early adoption of multiport video-assisted thoracoscopic surgery (VATS) in the 1990s revolutionized retained hemothorax treatment.

Purpose of the Study:

• To review the established and evolving surgical management strategies for hemothorax.
• To highlight the role of video-assisted thoracoscopic surgery (VATS) in treating retained and persistent hemothorax.
• To discuss the transition from multiport to uniportal VATS techniques in thoracic surgery.

Main Methods:

• Review of current cardiothoracic surgical tenets for hemothorax management.
• Emphasis on the diagnostic and therapeutic indications for multiport VATS.
• Discussion of the evolution towards uniportal VATS for hemothorax evacuation and other thoracic procedures.

Main Results:

• Multiport VATS has become the gold standard for retained hemothorax, enabling earlier diagnosis, complete clot removal, and improved patient outcomes.
• Optimal timing for hemothorax drainage is generally within the first 5 days post-onset for best results.
• Uniportal VATS offers a minimally invasive alternative, mimicking open surgery advantages with a single small incision.

Conclusions:

• VATS, particularly multiport, is highly effective for managing retained hemothorax, reducing morbidity and hospital stay.
• Uniportal VATS represents a significant advancement, utilized by experienced surgeons for hemothorax evacuation and complex thoracic interventions.
• Continued evolution in minimally invasive techniques enhances the treatment of thoracic conditions like hemothorax.