Thoracoscopy in chest trauma: an update

Abstract

The role of thoracoscopy in the management of patients with chest injuries is constantly being redefined as more reports on its use continue to emerge in the literature. As of today video-thoracoscopy has been used mainly as a diagnostic tool for certain occult injuries, such as of the diaphragm, as well as a minimally invasive management option in specific therapeutic situations including early evacuation of retained thoracic collections. It has the potential to replace open surgery in the management of more than 50% of civilian and military thoracic injuries previously considered candidates for open surgical management with all the benefits of minimally invasive surgery. In addition, it is a promising tool for earlier detection of missed injuries in patients otherwise managed nonoperatively. The procedure-related complication rate is low and there are only few contraindications for thoracoscopy, mainly haemodynamic instability and obliterated pleural space caused by previous infections or surgical interventions. However, the scientific evaluation of the global impact of thoracoscopy in the management of thoracic injuries is currently limited to descriptive series, some of them using historical controls, and a few non-randomized prospective studies. Until more well-designed, prospective, randomized studies emerge which compare thoracoscopy to standard management protocols in defined patient populations with thoracic injuries using relevant end points, the potential benefit of thoracoscopy in chest trauma remains unvalidated and its value is limited to isolated patients depending on individual surgeon’s preferences and skills.