The role of video-assisted thoracoscopy in chest trauma: a retrospective monocentric experience

Video-assisted thoracoscopy (VAT) plays an essential role in the exploration of pleural cavity after thoracic trauma, although some doubts about the precise and specific indications persist. This study examines the eligibility criteria for videothoracoscopy and establishes the ideal timing for VAT. Between January 2011 and November 2022, we observed 923 polytraumatized patients. All patients underwent computed tomography (CT) scan total body with and without contrast enhancement. Two hundred and nine patients carried out VAT within 10 ± 2 h of injury while 8 patients after 20 ± 1 h. The Injury Severity Score (ISS) was 31 ± 1 and the Glasgow Coma Scale was 14.1 ± 0.3 upon arrival at the hospital. One hundred and nineteen patients displayed hemothorax (55%), 62 hemopneumothorax (28.5%), 21 penetrating wound (9.6%), 10 pneumothorax (4.6%) and 5 chylothorax (2.3%). In 18 patients (8.3%) without vascular, diaphragmatic, or parenchymal lesion the treatment consisted in chest tube placement. VAT was converted to video-assisted thoracoscopic surgery (VATS) in 190 patients (87.5%), to open surgery in 8 (3.7%) and to laparoscopy in 1 (0.5%). Twelve patients (5.5%) with diaphragm ruptures < 5 cm in diameter were treated by separate stitches suture in VATS. Only eight postoperative complications (4 pneumonia, three atelectasis and one pulmonary embolism) out of 217 VAT, positively resolved with medical treatment, were noted exclusively in patients undergoing minimally invasive approach 20 ± 1 h after trauma. Early VAT in selected patients is a safe and easy procedure that ensure a quick diagnosis of lesions and an accurate management of the most thoracic injuries among trauma patients. The prompt identification of injuries, to avoid life-threatening conditions requiring rapid intervention, responds to medico-legal needs to which VAT fulfills.