Timing of video-assisted thoracoscopic surgery in the management of thoracic trauma

胸腔镜辅助手术在胸部创伤治疗中的时机选择

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Abstract

BACKGROUND: Tube thoracostomy is used as the first-choice surgical treatment method for thoracic injuries. Today, video-assisted thoracoscopic surgery is performed for diagnostic and treatment purposes in patients who cannot be treated with tube thoracostomy. OBJECTIVE: This study aim to evaluate the diagnostic and therapeutic processes of patients undergoing video-assisted thoracoscopic surgery and to determine the most appropriate time for the operation. METHODS: We evaluated 696 patients with blunt and penetrating thoracic injuries and analyzed data from 56 patients who underwent video-assisted thoracoscopic surgery. RESULTS: 25 (44.6%) of the patients had blunt trauma and 31 (55.4%) had penetrating trauma. Seven (12.5%) of the patients underwent late video-assisted thoracoscopic surgery, 17 (30.4%) of the patients underwent early video-assisted thoracoscopic surgery, and 32 (57.1%) of the patients underwent urgent video-assisted thoracoscopic surgery. It is seen that there has been a statistically significant relationship between the periods during which video-assisted thoracoscopic surgery was performed and the injuries detected during video-assisted thoracoscopic surgery (p = 0.016). A statistically significant difference has also been found between the periods when video-assisted thoracoscopic surgery was performed and the operation time, the number of patients receiving blood transfusion, and hospital stay (p = 0.001) (p = 0.001) (p = 0.012). CONCLUSIONS: It was determined that early video-assisted thoracoscopic surgery decreased the operation time, the need for blood transfusion and the length of hospital stay. Deciding correctly that tube thoracostomy is not effective in the treatment and making the decision to perform video-assisted thoracoscopic surgery at the earliest possible time in patient follow-up may prevent possible morbidity and mortality.

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