Early Video-assisted Thoracoscopic Surgery Research Articles

The role of the early video-assisted thoracoscopic surgery in children with pleural empyema.

Pleural empyema (PE) is a collection of purulent material in the pleural space. PE's management in children is a challenge and an inappropriate diagnostic-therapeutic work up can lead to serious short and long-term complications. The aim of this study is to define the correct timing to approach a pediatric PE by video-assisted thoracoscopic surgery (VATS). A retrospective observational study was conducted including pediatric patients who underwent video-assisted thoracoscopy for pleural empyema between May 2005 and September 2022. 62 patients were subjected to VATS for PE (32 in Group Early VATS, 30 in Group Late VATS). It emerged that the elapsed period between the onset of symptoms and surgery correlates in a statistically significant way with the post-operative stay in intensive care (z score 4.3 and p value < 0.0001) and the analysis between early VATS, late VATS and postoperative hospitalization showed a statistically significant reduction of the post-operative hospitalization in the early VATS groups (p value < 0.02). VATS resulted to be safe and effective for the treatment of PE in children, and an early minimally invasive thoracoscopic intervention (early VATS) correlates with better outcomes, specifically in terms of intensive care hospitalization and overall hospitalization.

The application of electrical impedance tomography and surgical outcomes of thoracoscope-assisted surgical stabilization of rib fractures in severe chest trauma

Serious blunt chest trauma usually induces hemothorax, pneumothorax, and rib fractures. More studies have claimed that early video-assisted thoracoscopic surgery with surgical stabilization of rib fractures (SSRF) results in a good prognosis in patients with major trauma. This study aimed to verify the outcomes in patients with chest trauma whether SSRF was performed. Consecutive patients who were treated in a medical center in Taiwan, for traumatic events between January 2015 and June 2020, were retrospectively reviewed. This study focused on patients with major trauma and thoracic injuries, and they were divided into groups based on whether they received SSRF. We used electrical impedance tomography (EIT) to evaluate the change of ventilation conditions. Different scores used for the evaluation of trauma severity were also compared in this study. Among the 8396 patients who were included, 1529 (18.21%) had major trauma with injury severity score > 16 and were admitted to the intensive care unit initially. A total of 596 patients with chest trauma were admitted, of whom 519 (87%) survived. Younger age and a lower trauma score (including injury severity scale, new injury severity score, trauma and injury severity score, and revised trauma score) account for better survival rates. Moreover, 74 patients received SSRF. They had a shorter intensive care unit (ICU) stay (5.24, p = 0.045) and better performance in electrical impedance tomography (23.46, p < 0.001). In patients with major thoracic injury, older age and higher injury survival scale account for higher mortality rate. Effective surgical stabilization of rib fractures shortened the ICU stay and helped achieve better performance in EIT. Thoracoscope-assisted rib fixation is suggested in severe trauma cases.

Late video-assisted thoracoscopic surgery versus thoracostomy tube reinsertion for retained hemothorax after penetrating trauma, a prospective randomized control study.

Early video-assisted thoracoscopic surgery (VATS) is the recommended treatment of choice for retained hemothorax (RH). A prospective single-center randomized control study was conducted to compare outcomes between VATS and thoracostomy tube (TT) reinsertion for patients with RH after penetrating trauma in a resource constrained unit. Our hypothesis was that patients with a RH receiving VATS instead of TT reinsertion would have a shorter hospital stay and lesser complications. From January 2014 to November 2019, stable patients with thoracic penetrating trauma complicated with retained hemothoraces were randomized to either VATS or TT reinsertion. The outcomes were length of hospital stay (LOS) and complications. Out of the 77 patients assessed for eligibility, 65 patients were randomized and 62 analyzed: 30 in the VATS arm and 32 in the TT reinsertion arm. Demographics and mechanisms of injury were comparable between the two arms. Length of hospital stay was: preprocedure: VATS 6.8 (+/-2.8) days and TT 6.6 (+/- 2.4) days (p=0.932) and postprocedure: VATS 5.1 (+/-2.3) days, TT 7.1 (+/-6.3) days (p=0.459), total LOS VATS 12 (+/- 3.9) days, and TT 14.4 (+/-7) days (p=0.224). The TT arm had 15 complications compared to the VATS arm of four (p=0.004). There were two additional procedures in the VATS arm and 10 in the TT arm (p=0.014). VATS proved to be the better treatment modality for RH with fewer complications and less need of additional procedures, while the LOS between the two groups was not statistically different.

Pleural empyema after COVID-19: A delayed presentation

Globally, the number of coronavirus disease-2019 (COVID-19) cases and deaths shows a declining trend since a peak in January 2022. For now, the pandemic phase looks to be ended, until a severe new variant may trigger another wave. At present, in India, small pockets of COVID-19 cases and post-COVID complications are still being reported. Therefore, physicians should remain vigilant about the atypical presentations and potential delayed or long-term complications of SARS-CoV-2 infection, even in individuals who had a mild COVID-19 infection. Here, we present the case of a 52-year-old male patient with a history of hypertension, who is a non-smoker and developed culture-negative pleural empyema 7 months after a mild COVID-19 infection. The patient was successfully treated with antibiotics and early video-assisted thoracoscopic surgery.

Scoring Tool to Predict Need for Early Video-Assisted Thoracoscopic Surgery (VATS) After Pediatric Trauma

BackgroundNo widely used stratification tool exists to predict which pediatric trauma patients may require a video-assisted thoracoscopic surgery (VATS). We sought to develop a novel VATS-In-Pediatrics (VIP) score to predict the need for early VATS (within 72 h of admission) for pediatric trauma patients.MethodsThe pediatric 2017–2020 Trauma Quality Improvement Program database was used and divided into two sets (derivation set using 2017–2019 data and validation set using 2020 data). First, multiple logistic regression models were created to determine the risk of early VATS for patients ≤ 17 years old. Second, the weighted average and relative impact of each independent predictor were used to derive a VIP score. We then validated the score using the area under the receiver operating characteristic (AROC) curve.ResultsFrom 218,628 patients in the derivation set, 2183 (1.0%) underwent early VATS. A total of 8 independent predictors of VATS were identified, and the VIP score was derived with scores ranging from 0 to 9. The AROC for this was 0.91. The VATS rate increased steadily from 12.5 to 32% then 60.5% at scores of 3, 4, and 6, respectively. In the validation set, from 70,316 patients, 887 (1.3%) underwent VATS, and the AROC was 0.91.ConclusionsVIP is a novel and validated scoring tool to predict the need for early VATS in pediatric trauma. This tool can potentially help hospital systems prepare for pediatric patients at high risk for requiring VATS during their first 72 h of admission. Future prospective research is needed to evaluate VIP as a tool that can improve clinical outcomes.

Clinical Profile and Outcome of Children with Empyema Thoracis in Tertiary Hospital

Introduction: Empyema thoracis (ET) is an accumulation of pus in the pleural space. It is a common condition in childhood having significant morbidity and mortality. The clinical manifestations of empyema are high grade fever with chills and rigors, cough, breathlessness, chest pain. The present study analyses the epidemiological aspects of the disease, etiological agents, clinical features and associated lesions in diagnosis of empyema and the outcome of early Video-assisted thoracoscopic surgery (VATS) on morbidity of disease in children.&#x0D; Objectives: To study various demographic characteristic and to evaluate various management strategies and outcome in children with empyema thoracis.&#x0D; Methodology: This is a prospective hospital based observational study, conducted at Nobel Medical College Teaching Hospital Biratnagar, from December 2021 to November 2022. All children in the age group of 1month to 16 years diagnosed pyogenic empyema by lights criteria during the study are included in the study. Children below 1 month of age and pleural effusion not meeting the criteria for exudative pleural effusion by Light's criteria are excluded from the study.&#x0D; Results: Majority of the study population are in the age group of &gt;5 years. Males are more common than females. Most common clinical feature was fever followed by cough, chest pain and shortness of breath. Culture is positive in 68% out of which 32% is staphylococcus aureus, 20% is mycobacterium tuberculosis ,16% is streptococcus pneumonia. Duration of illness is &lt;1week in 48% of the children, 1-2weeks in 40% and &gt;3weeks in 12% of the children. In 80% of the children there is unilateral involvement in the x- ray chest. In the children who are uncomplicated all of them had intercoastal chest tube drain (ICD) usage,76.4% had urokinase therapy and 5.8% had undergone thoracotomy and none of them had need for surgery. In the children with complication 87.5% had ICD usage and urokinase therapy,25% of them had undergone thoracotomy and 12.5% had need for surgery.&#x0D; Conclusion: Empyema thoracis is more commonly seen in the males of the group&gt;5 years with duration of illness &lt;1 week maned mostly by ICD usage, where there was mostly unilateral involvement in x ray chest.

Management of Primary Spontaneous Pneumothorax in Children: A Single Institution Protocol Analysis

BackgroundThe Midwest Pediatric Surgery Consortium (MWPSC) suggested a simple aspiration of primary spontaneous pneumothorax (PSP) protocol, failing which, Video-Assisted Thoracoscopic Surgery (VATS) should be considered. We describe our outcomes using this suggested protocol. MethodsA single institution retrospective analysis was conducted on patients between 12 and 18 years who were diagnosed with PSP from 2016 to 2021. Initial management involved aspiration alone with a ≤12 F percutaneous thoracostomy tube followed by clamping of the tube and chest radiograph at 6 h. Success was defined as ≤2 cm distance between chest wall and lung at the apex and no air leak when the clamp was released. VATS followed if aspiration failed. ResultsFifty-nine patients were included. Median age was 16.8 years (IQR 15.9, 17.3). Aspiration was successful in 33% (20), while 66% (39) required VATS. The median LOS with successful aspiration was 20.4 h (IQR 16.8, 34.8), while median LOS after VATS was 3.1 days (IQR 2.6, 4). In comparison, in the MWPSC study, the mean LOS for those managed with a chest tube after failed aspiration was 6.0 days (±5.5). Recurrence after successful aspiration was 45% (n = 9), while recurrence after VATS was 25% (n = 10). Median time to recurrence after successful aspiration was sooner than that of the VATS group [16.6 days (IQR 5.4, 19.2) vs. 389.5 days (IQR 94.1, 907.0) p = 0.01]. ConclusionSimple aspiration is safe and effective initial management for children with PSP, although most will require VATS. However, early VATS reduces length of stay and morbidity. Level of evidenceIV. Retrospective study.

Early video-assisted thoracoscopic surgery (VATS) for non-emergent thoracic trauma remains underutilized in trauma accredited centers despite evidence of improved patient outcomes

Thoracic injury is a major contributor to morbidity in trauma patients. There is limited data regarding practice patterns of video-assisted thoracoscopic surgery (VATS) across trauma-accredited hospitals in the United States. We hypothesized that early VATS remains underutilized affecting patient outcomes. We evaluated a cohort of patients who underwent non-urgent thoracic surgical intervention for trauma from the ACS-TQIP database in 2017 excluding patients who were discharged within 48-h or died within 72-h. We selected patients who underwent partial lung resection and decortication to assess the effect of early (day 2-5) versus late VATS. Univariate followed by multivariate regression analyses were utilized to evaluate the independent impact of timing. Over 12months, 997,970 patients were admitted to 850 trauma-accredited centers. Thoracic injury occurred in 23.5% of patients, 1% of whom had non-urgent thoracic procedures. A total of 406 patients underwent VATS for pulmonary decortication with/out partial resection, 39% were Early VATS (N = 159) compared to 61% late VATS (N = 247). Both groups had comparable demographics and comorbidities with exception of a higher ISS score in the late surgical group (17.9 ± 9.8 vs 14.9 ± 7.6, p < 0.01). The late VATS patients' group had higher rates of superficial site infection, unplanned intubation, and pneumonia. Early VATS was associated with shorter ICU stay and HLOS. Multivariate analysis confirmed the independent effect of surgical timing on postoperative complications and LOS. The conversion rate from VATS to thoracotomy was 1.9% in early group compared to 6.5%, p = 0.03. There was no difference in surgical pattern among participating facilities. Despite established practice guidelines supporting early VATS for thoracic trauma management, there is underutilization with less than half of patients undergoing early VATS. Early VATS is associated with improved patient outcomes.

Video-Assisted Thoracoscopic Surgery in Community-Acquired Thoracic Empyema: Analysis of Risk Factors for Mortality.

Background: Thoracic empyema is a disease with high mortality and morbidity. Video-assisted thoracoscopic surgery (VATS) is recommended to treat advanced stage empyema. The purpose of this study was to explore risk factors associated with post-surgery mortality for community-acquired empyema. Patients and Methods: We retrospectively reviewed 440 patients who received VATS for community-acquired empyema, higher than stage 2, in a tertiary medical center in Taiwan. Patients' age, comorbidities, pleural effusion analysis, and post-surgery outcome were compiled. Cox regression model for survival was applied to identify risk factors of 90-day death after surgery. Results: Fifty-three patients (12.05%) had died within 90 days post-surgery. The risk factors of mortality were advanced age (hazard ratio [HR], 1.027; 95% confidence interval [CI], 1.001-1.052), chronic kidney disease (HR, 5.322; 95% CI, 2.635-10.746), cancer (HR, 6.038; 95% CI, 2.737-13.321), pleural effusion pH ≤7 (HR, 2.61; 95% CI, 1.344-5.069), pleural effusion protein ≤4 (HR, 2.021; 95% CI, 1.035-3.947), and late surgery (HR, 3.014; 95% CI, 1.595-5.696). The 90-day mortality in the early surgery group versus the late group was 6.85% versus 26.05%. The increased mortality risk from late surgery was observed in most subgroups, except for patients who were female, had chronic renal disease, and had coronary artery disease. Conclusions: Patients who are elderly, have chronic kidney disease, cancer history, low pleural effusion pH, low pleural effusion protein, and late surgery are associated with post-surgery mortality for community-acquired advanced empyema. Early VATS surgery for advanced empyema or treatment failure of chest tube drainage appears to beneficial and is recommended.

Pleural empyema management: The impact of Video-assisted thoracoscopic surgery

In recent years, Video-assisted Thoracoscopic Surgery (VATS) has caused many changes in thoracic surgery practice. This study aimed to analyze the results of early VATS surgery in patients with empyema. Thirty-two cases of empyema who underwent VATS drainage, debridement, pleural pouch jointing, and partial decortication between November 2018 and June 2022 were included in the study retrospectively. The cases were examined for demographic information, the duration of symptoms, the stages of empyema, treatment outcomes, and complications. Twenty-three (79.9%) cases were male, 9 (28.1%) were female, and the mean age was 46.4±19.9. Preoperative symptom duration was 2.68±1.46 weeks. 28 (87.5%) cases were in stage 2 and 4 (12.5%) cases were in stage 3 empyema. A single incision VATS was performed in 23 (71.9%) cases, and double incision VATS was performed in 9 (28.1%) cases. Postoperative hospital stay was 12.1±3.3 days. Acceptable symptomatic and radiological improvement was observed in 28 (87.5%) cases after VATS. Pleural decortication with thoracotomy was used in four (12.5%) cases of stage 3 empyema. In cases of stage 2 empyema, which occurs within the first four weeks of the onset of symptoms, the VATS procedure with drainage, debridement, pouch jointing, and partial decortication provides curative results. We recommend evaluating VATS as the first-line therapy in treating early-stage empyema.

Early Video-Assisted Thoracoscopic Surgery for Retained Hemothorax Is Associated with Higher Mortality in the Most Severely Injured Patients

Early Video-Assisted Thoracoscopic Surgery for Retained Hemothorax Is Associated with Higher Mortality in the Most Severely Injured Patients

Early Surgery for Spontaneous Pneumothorax Associated With Reduced Recurrence, Resource Utilization

Primary spontaneous pneumothorax (PSP) occurs in adolescent patients and frequently recurs. Reliable predictors of recurrence may identify candidates for early VATS (video-assisted thoracoscopic surgery). We hypothesize that demographic and clinical factors are associated with recurrence, and that earlier surgery is associated with decreased recurrence and resource utilization. Patients between ages 5 and 21 treated for PSP at a single center from January 1, 2008 to June 30th, 2019 were identified. Presenting demographics, clinical management, and outcomes were analyzed, with focus on the first admission for PSP. "Early VATS" was defined as VATS during the first admission, and "late VATS" as VATS at any point after the first admission for a given side. Thirty-nine patients met inclusion criteria, with a total of 82 pneumothoraces. Following initial encounter, 48.7% had ipsilateral recurrence. Early VATS was associated with less recurrence (P=0.002). No other predictive factors were associated with ipsilateral recurrence. Early VATS was associated with reduced overall recurrence (P < 0.001), admissions (P < 0.001), cumulative chest x-rays (P=0.043), and cumulative hospital length of stay (P=0.022) compared to late VATS. While predictors of recurrence are not apparent at initial admission, early VATS is associated with decreased recurrence and resource utilization.

Tracking the outcomes of surgical treatment of Stage 2 and 3 empyema: introduction and consolidation of minimally invasive approach.

We described the results of surgical treatment of empyema, tracing outcomes throughout the passage from the open thoracotomy (OT) approach to video-assisted thoracoscopic surgery (VATS) in a single institute. We retrospectively analyzed the records of 88 consecutive patients treated for Stage 2 and 3 empyema (2010-2019). We divided the study period into three groups: OT period (2010-2013), early VATS (2014-2017, from the introduction of VATS program, until acme of learning curve), and late VATS (2018-2019). Groups were compared to investigate the outcomes evolution. Most relevant findings of the study were significant variation in postoperative length of stay (median [interquartile range]: 9 days [7.5-10], 10 [7.5-17.5], and 7 [5-10] for OT period, early VATS, and late VATS, respectively, p=0.005), hospital admission referral to thoracic surgery interval (7.5 days [4.5-11], 6.5 [3-9], and 2.5 [1.5-5.5], p=0.003), chest tube duration (5.5 days [5-7.5], 6 [4-6], 4 [3-5], p=0.003), and proportion of operation performed by residents (3 [15%], 6 [16.7%], 14 [43.6%], p=0.01). Our findings pictured the trajectory evolution of outcomes during introduction and consolidation of VATS treatment of empyema. During the early phase, we observed a decline in some indicators that improved significantly in the late VATS period. After a learning curve, all outcomes showed better results and we entered into a teaching phase.

Empyema in Children - Is Primary VATS the Preferred Strategy

Introduction: Empyema thoracis (ET) is an accumulation of pus in the pleural space. Considering the advantages of Video Assisted Thoracoscopic surgery (VATS), including reduced length of hospitalisation, lower postoperative morbidity and mortality, VATS is the treatment of choice for cases of stage 3 empyema. The objective of this study was to study the age-sex profile, clinical presentation, etiologic agents, management and the overall treatment outcome of empyema thoracis after early VATS in children.&#x0D; Methods: This was a retrospective observational study, conducted in the Department of Paediatrics, Rangadore Memorial Hospital, Bangalore, from November 2018 to March 2020. All children in the age group of 0 to 18 years diagnosed to have pyogenic empyema and presenting in stage 1 and 2 during the study period were included in the study. In the present study, 15 children were found to be having empyema (stage 1 and 2).&#x0D; Results: Majority of patients (66.6%) were seen in the age group of one to five years. Fever (100%), breathlessness (66.66%), and cough (80%) were the commonest presenting features. Bacteriological isolation was possible only in three cases (20%). Patients were treated with antibiotics and primary VATS in majority of cases (55.33%). Average duration of hospital stay in VATS group was 12.11 days.&#x0D; Conclusions: Empyema thoracis mainly affects younger children. Common presenting features are fever, difficulty in breathing and cough. Appropriate antibiotics and early VATS may be acceptable modality for management of pyogenic empyema thoracis in children.

Risk factors for conversion to thoracotomy from video-assisted thoracoscopic surgery of lung cancer

ObjectivesIntraoperative conversion to thoracotomy from video-assisted thoracoscopic surgery (VATS) is associated with increased adverse events, which is a major concern. We aim to explore the related risk factors in lung cancer patients. MethodsIn our study, the data from 1305 patients who underwent VATS between June 2017 and May 2020 were retrospectively collected, among which 67 patients underwent unexpected conversion to thoracotomy. All patients were divided into Non-conversion Group or Conversion Group according to whether they required a conversion to thoracotomy and the risk factors were explored by univariate and multivariate analyses. ResultsThe most common cause of conversion was fibrocalcified lymph nodes, found in 33 patients (49.3%). Multivariable logistic regression analysis demonstrates that the independent risk factors for the conversion were age ≥65 y (OR = 2.696, 95% CI: 1.487–4.887, p = 0.001), tumor size >3 cm (OR = 4.527, 95% CI: 2.490–8.233, p < 0.001), and tumor location in the left upper lung (OR = 3.809, 95% CI: 1.737–5.492, p < 0.001). ConclusionsAdvanced age, bigger tumor size and tumor at the left upper lobe could lead to conversion. In the early VATS learning cases, surgeons should try to choose patients with lower risk of conversion to thoracotomy.

Video assisted thoracoscopic surgery in the management of acute fibrinopurulent empyema in paediatric patients

Background: Empyema is the presence of pus in the pleural space that usually follows an episode of pneumonia in pediatric age group. The aim of this study was to assess the efficacy of management of acute fibrinopurulent stage of empyema by early video assisted thoracoscopic surgery (VATS) in paediatric patients.Methods: The study was carried out at a tertiary care hospital in India. It was a prospective interventional observational study. The study included 40 children between age group 0-12 years attending the surgery in-patient department referred for further management of parapneumonic effusions who had clinical and radiological evidence of empyema and thoracocentesis confirmed purulent exudate in pleural cavity, were subjected to early VATS after thorough pre-operative workup.Results: The mean age was 7.22 years. Average operative time was 135.5 minutes. The mean duration of hospital stay was 7.5 days. Few complications were bleeding, superficial wound infection, bronchopleural fistula, pneumothorax, recurrence of empyema and incomplete expansion of lung.Conclusions: VATS facilitates the management of fibrinopurulent and organised pyogenic pleural empyema with less post-operative discomfort and complications and reduced hospital stay. However larger sample size study is required to come to a definitive conclusion.

Timing to perform VATS for traumatic-retained hemothorax (a systematic review and meta-analysis).

In this systematic review, we analyzed the optimal time range to evacuate traumatic-retained hemothorax using video-assisted thoracoscopic surgery (VATS). We searched PubMed, EMBASE, the Cochrane Register of Controlled Trials, Google Scholar, and the U.S. National Library of Medicine clinical trials database up to February 2019. Randomized controlled trials (RCTs) and observational studies with relevant data were included. Data were extracted from studies that reported the success, mortality, or length of hospital stay (LOS) after using VATS during at least two out of three of our time-ranges of interest: days 1-3 (group A), days 4-6 (group B), and day 7 or later (group C). Six cohort studies with 476 total participants were included in the meta-analysis. The patients in group A had a significantly higher success rate than those in group C (RR = 0.42; 95% CI = 0.21-0.84, p = 0.01). The total LOS for patients whose retained hemothorax was evacuated in group A was 4.7days shorter than that for those in group B (95% CI = - 5.6 to - 3.8, p = 0.006). Likewise, group B patients were discharged 18.1days earlier than group C patients (95% CI = - 22.3 to - 14, p < 0.001). Short-term mortality was not decreased by early VATS. Our results indicate that VATS should be considered within the first three days of admission if this intervention is the clinician's choice to evacuate a traumatic-retained hemothorax. Protocol registration number in PROSPERO: CRD42017046856.

The advantages of adding rib fixations during VATS for retained hemothorax in serious blunt chest trauma – A prospective cohort study

BackgroundSerious blunt chest trauma usually induces hemothorax, pneumothorax, and rib fracture. Early video-assisted thoracoscopic surgery (VATS) to evacuate retained hemothorax is one commonly used treatment. In this study, a new strategy was implemented to combine VATS with fractured rib fixation simultaneously. MethodsThis prospective observational study was performed from January 2013 to April 2018. All patients were aged 18 years or older and had blunt chest trauma with displaced fractures in more than three ribs. No patients had acute respiratory failure within 24 h after trauma. Patients with retained hemothorax who received VATS constituted the study cohort. Subsequently, patients who received rib fixation during VATS procedures were compared with those who did not. Clinical outcomes such as dose of analgesics, and length of hospital stay were recorded. ResultsDuring the study period, 128 patients were enrolled. Available demographic characteristics of the 2 groups were compared, and no statistical differences were observed. The rates of shorter temporary ventilator dependence after operations were lower in the rib fixation group (0% vs. 24.7%, P = 0.017). Persistent air leakage more than 5 days after operations were also lower in the rib fixation group (0% vs. 10.4%, P = 0.001). The length of stay in overall hospital stay were longer for patients who received VATS without rib fixation (9.29 ± 2.51 days vs. 12.39 ± 4.65, P = 0.001). Furthermore, the rib fixation group were administered much lower doses of opiates during their hospital stays (52.45 ± 15.67 mg vs. 77.24 ± 50.42 mg, P = 0.001). ConclusionAdding rib fixation during VATS in the management of retained hemothorax can contribute to shorten whole treatment courses. Rib fixation can also reduce pain, thus reducing dependence on analgesics.

Early Management of Retained Hemothorax in Blunt Head and Chest Trauma

BackgroundMajor blunt chest injury usually leads to the development of retained hemothorax and pneumothorax, and needs further intervention. However, since blunt chest injury may be combined with blunt head injury that typically requires patient observation for 3–4 days, other critical surgical interventions may be delayed. The purpose of this study is to analyze the outcomes of head injury patients who received early, versus delayed thoracic surgeries.Materials and methodsFrom May 2005 to February 2012, 61 patients with major blunt injuries to the chest and head were prospectively enrolled. These patients had an intracranial hemorrhage without indications of craniotomy. All the patients received video-assisted thoracoscopic surgery (VATS) due to retained hemothorax or pneumothorax. Patients were divided into two groups according to the time from trauma to operation, this being within 4 days for Group 1 and more than 4 days for Group 2. The clinical outcomes included hospital length of stay (LOS), intensive care unit (ICU) LOS, infection rates, and the time period of ventilator use and chest tube intubation.ResultAll demographics, including age, gender, and trauma severity between the two groups showed no statistical differences. The average time from trauma to operation was 5.8 days. The ventilator usage period, the hospital and ICU length of stay were longer in Group 2 (6.77 vs. 18.55, p = 0.016; 20.63 vs. 35.13, p = 0.003; 8.97 vs. 17.65, p = 0.035). The rates of positive microbial cultures in pleural effusion collected during VATS were higher in Group 2 (6.7 vs. 29.0%, p = 0.043). The Glasgow Coma Scale score for all patients improved when patients were discharged (11.74 vs. 14.10, p < 0.05).DiscussionIn this study, early VATS could be performed safely in brain hemorrhage patients without indication of surgical decompression. The clinical outcomes were much better in patients receiving early intervention within 4 days after trauma.

Evolving role of video-assisted thoracoscopic surgery in the management of spontaneous primary and secondary pneumothorax

Background: Video-assisted thoracoscopic surgery (VATS) has been increasingly advocated as the preferred treatment for the first episode of primary spontaneous pneumothorax (PSP), in contrast to the current guidelines of the American College of Chest Physicians and the British Thoracic Society recommending tube thoracostomy. Materials and Methods: We retrospectively reviewed the medical records of our patients who underwent VATS for primary or secondary SP from January 2005 to December 2015. Results: There were 36 patients, with the mean age of 43.6 ± 20.5 years, and 72.2% of them were male and 66.7% with PSP. 75.0% of SSP patients had chronic obstructive pulmonary disease versus 0% for PSP (P = 0.001). 50% of PSP and 66.7% of SSP patients had experienced previous SP. About 16.7% (PSP) and 0% (SSP) of patients with index pneumothorax and 75.0% (PSP) and 25.0% (SSP) of patients with multiple pneumothoraces underwent early VATS, while the remaining had delayed VATS for a prolonged air leak. Postoperative air leak occurred in 1 (4.2%) PSP patient, which healed with doxycycline pleurodesis, and in 4 (33.3%) SSP patients, which required thoracotomy in three patients and redo-VATS in one patient for control. Operative mortality was 0% versus 8.3% for PSP and SSP, respectively (P = 0.351). In patients with extended follow-up, ipsilateral recurrence occurred only in one SSP patient at 36 months. Conclusion: Index SP was mostly treated by the tube thoracostomy, except for recent years, when VATS was recommended to young adult patients with index PSP, because of zero operative mortality, lower recurrence, and less time away from work or school. However, for SSP patients, VATS was reserved primarily for persistent air leak or recurrence.