Role of uniportal video-assisted thoracoscopic surgery in the management of penetrating thoracic injuries

Chest-related injuries account for 25% of trauma-related mortality. Penetrating chest trauma is less common than blunt trauma; however, it is more deadly, accounting for a mortality rate of about 1.5% [1]. The vast majority of penetrating chest trauma can be safely managed by thoracostomy tube drainage. However, approximately 14% of patients with stab wounds may require early operative intervention to control bleeding or repair damaged internal organs [2]. Current guidelines for the management of penetrating chest injuries advocate for urgent thoracotomy if an acute evacuation of blood on tube placement exceeds 1500 ml or there is persistent bleeding of 200 ml per hour for 2 to 4 hours [2]. Open thoracotomy incision contributes to the morbidity, mortality and prolonged painful recovery of the patient mainly due to the extent of the incision. This provided the incentive to develop less invasive methods to manage thoracic trauma.
With the recent advances in minimal access thoracic procedures, video-assisted thoracoscopic surgery (VATS) provided an alternative method to diagnose and simultaneously treat any thoracic injury. Papers showed that VATS compared to open thoracotomy in hemodynamically stable patients with chest trauma had a favorable post-operative period, superior long-term outcome and greater patient satisfaction [3]. The first progress was in uniportal VATS conducted by Prof. Rocco in which uniportal VATS was performed for pleural effusion, pleurodesis, pleural and mediastinal biopsies, and lung wedge resections [4]. A breakthrough in uniportal VATS was first reported by Dr. Gozalez Rivas when he performed major lung resection with radical lymphadenectomy for non-small cell lung cancer (NSCLC) [1].
This study evaluates the feasibility and safety of uniportal VATS for the management of penetrating stab wounds of the chest in the emergency setting.
This a retrospective review of all uniportal VATS performed for the management of penetrating stab wounds of the chest. Between September 2016 and December 2019 a total of 21 patients underwent emergent thoracic surgery due to penetrating injury, 19 of the operations performed using uniportal VATS. The inclusion criteria were: uniportal VATS approach for the management of hemodynamically stable patients with active bleeding after penetrating stab injuries to the chest outside the cardiac box and with a chest drain output of more than 1500 ml of blood on chest tube insertion. The...


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