Video-assisted thoracoscopic surgery (VATS) in trauma: a narrative review

Background and Objective: Video -assisted thoracoscopic surgery (VATS) techniques have expanded rapidly in elective thoracic surgery over the past several decades. During the same time, the role of minimally invasive therapies in trauma surgery, such as laparoscopy and endovascular interventions, have also expanded tremendously. VATS is being increasingly utilized in the care of trauma patients, however the role of VATS in the management of an acute injured patient or in the management of the sequalae of traumatic injury is not well defined in guidelines. The purpose of this narrative review is to provide the reader with the most up-to-date evidence regarding the utility of VATS in trauma surgery. Methods: We performed a literature review of studies describing the use of thoracoscopy in trauma patients in PubMed. There were no date restrictions. The review was limited to studies written in English. Studies were included for evaluation based on the title and abstract, and subsequently reviewed in detail by the authors. Additional studies regarding injury patterns and management techniques were queried and reviewed as necessary. Key Content and Findings: The most common indication for VATS in trauma, and intervention that is best supported by data, is evacuation of retained hemothorax. The use of VATS is also well supported and commonly utilized in acute hemothorax in a hemodynamically stable patient, persistent pneumothorax or prolonged air leak, diagnosis and treatment of hemopericardium in select patients, and diagnosis and treatment of diaphragm injuries. Minimally invasive approaches to surgical stabilization of rib fractures are under development, but the precise role of surgical management of rib fractures and flail chest is not well established. Conclusions: A growing body of evidence supports the use of VATS in the management of acutely injured patients with thoracic injuries as well as traumatically injured patients with sub -acute or chronic sequelae of their injures.