PRELIMINARY-REPORT ON VIDEOTHORACOSCOPY IN THE EVALUATION AND TREATMENT OF THORACIC INJURY

A prospective trial of videothoracoscopy was conducted at an urban tra uma center between February 1992 and February 1993 to determine the ef ficiency of this less invasive method of evaluation and treatment. Twe nty-four consecutive patients with chest trauma (penetrating, n = 22; blunt, n = 2) were examined thoracoscopically for clotted hemothorax t hat otherwise would have been treated with thoracotomy (n = 9), suspec ted diaphragmatic injury (n = 10), and continued bleeding (n = 5). To ensure maximal exposure, general anesthesia with a double-lumen endotr acheal tube was used in each patient. Clotted hemothorax was successfu lly evacuated in eight of nine patients (89%). Diaphragmatic laceratio n was suspected in 10 patients (2 abnormal chest radiographs, 8 proxim ity penetrating wounds) and confirmed thoracoscopically in 5. In four patients, diaphragmatic lacerations were successfully repaired with th oracoscopic techniques. Five patients underwent thoracoscopy for conti nued hemorrhage (greater than 1,500 mL per 24 hours) after tube thorac ostomy. Intercostal artery injury was confirmed in all patients, and d iathermy provided hemostasis in three patients without thoracotomy. No complications occurred. These data suggest the following: (1) Videoth oracoscopy is an accurate, safe, and minimally invasive method for the assessment of diaphragmatic injuries, control of continued chest wall bleeding, and early evacuation of clotted hemothorax. (2) This techni que should be used more frequently in patients with thoracic trauma. ( 3) Technical advances may expand the therapeutic role of thoracoscopy.