Utility of VATS in Thoracic Trauma: When? Why? and How?

Abstract

Background: Thoracoscopy/VATS is an under utilized modality in thoracic trauma. In this article we aim to review the utility of thoracoscopy in chest trauma patients. We have also illustrated a case from our hospital, to demonstrate the effective use of VATS in trauma. Main Body: Indications for VATS in trauma can be divided into emergency, early and late, based on the timing of the intervention. In emergency situations, if the patient is hemodynamically stable, VATS can be used to control bleeding from the chest wall and intercostal vessels, it can also be useful for evacuation of clots, removal of foreign bodies, diagnosing diaphragmatic injuries and to visualize other internal organs of the thoracic cavity. In a delayed setting it can be used for evaluation and control of persistent pneumothorax, repair of lung lacerations and diaphragmatic injuries and also for fixing rib fractures. Uniportal VATS is a new technology that is coming up quickly, but is yet to be proven superior to traditional 3 port VATS in chest trauma. Conclusion: VATS is an important tool in the armamentarium of surgeons involved in dealing with chest trauma. However, it is not a substitute for emergency thoracotomy, but can only be a supplement to it.