The role of thoracoscopy in management of chest trauma
Ahmed Ibrahim Amin Hatab;
Abstract
The optimal approach to the thorax depends on a number of variables: bony anatomy, location and extent of the pathology, location of the hilum, and objectives of the procedure.
Historically, The first thoracoscopy, using a modified cystoscope, was done by Hans Christian Jacobaeus in 1910 to divide intrapleural adhesions, then spread all over the world in spite of a significant incidence of complications. Its use declined rapidly after the introduction of streptomycin in 1945.
The posterolateral thoracotomy had a major role in managing chest traumas for the majority of thoracic procedures. With the movement toward minimally invasive procedures in both cardiac and general thoracic surgery, there has been renewed interest in additional approaches, such as the anterior thoracotomy and muscle-sparing incisions.
Video assisted thoracoscopic surgery (VATS) is a new technique in which standard procedures are performed utilizing a video camera in a much less invasive manner than a standard thoracotomy. These approaches may favorably affect morbidity, operative time, postoperative pulmonary function, muscle strength, Less inflammatory response, the reduction of post operative pain which increases the possibility of hypoxia and myocardial oxygen demand.
VATS should be carried out under general anesthesia with selective single-lung ventilation. This can usually be accomplished using a double-lumen endotracheal tube. A biopsy forceps, scissors or electrocautery, suction, irrigator are the primary tools used in thoracoscopy.
VATS provides panoramic view of the intrathoracic anatomy, expanded field of vision which allows generous percutaneous dissection, This dissection can be performed by the surgeon while the assistant is manipulating the instruments and the camera man is operating the videoscope as all of them can see the anatomy on the video-monitor simultaneously.
VATS plays a major role in managing chest traumas as it has an accuracy of almost 100% in diagnosing injuries of the diaphragm. Generally speaking, the rate of missed diagnosis using VATS for chest trauma is 0.8%, with a 2% rate of procedure-related complications.
Most of the thoracic traumas do not require major procedures and tube thoracotomy remains the basis of the treatment. Rapid improvements in endoscopic surgical technique and instrumentation expanded the indications of video-thoracoscopy in both diagnosis and treatment of chest traumas.
VATS has been used in both diagnosis and treatment of variant entities of chest traumas as diagnosis of diaghragmatic injuries after penetrating trauma and post-traumatic empyema, chylothorax, mediastinal masses and infections, excision of bronchial cysts, diaphragmatic hernias and injuries, and esophageal surgeries, retained haemothorax and persistent pneumothorax, also in management of ongoing bleeding.
Other than its huge importance in managing chest traumas, VATS is used in various thoracic surgical problems as wedge resection of peripheral pulmonary nodules, closed lung biopsy, approach to apical bullae, aortopulmonary window, mediastinal masses, and lung resection,lung biopsy, cancer and node biopsy, sympathectomy and esophagomyotomy.
Historically, The first thoracoscopy, using a modified cystoscope, was done by Hans Christian Jacobaeus in 1910 to divide intrapleural adhesions, then spread all over the world in spite of a significant incidence of complications. Its use declined rapidly after the introduction of streptomycin in 1945.
The posterolateral thoracotomy had a major role in managing chest traumas for the majority of thoracic procedures. With the movement toward minimally invasive procedures in both cardiac and general thoracic surgery, there has been renewed interest in additional approaches, such as the anterior thoracotomy and muscle-sparing incisions.
Video assisted thoracoscopic surgery (VATS) is a new technique in which standard procedures are performed utilizing a video camera in a much less invasive manner than a standard thoracotomy. These approaches may favorably affect morbidity, operative time, postoperative pulmonary function, muscle strength, Less inflammatory response, the reduction of post operative pain which increases the possibility of hypoxia and myocardial oxygen demand.
VATS should be carried out under general anesthesia with selective single-lung ventilation. This can usually be accomplished using a double-lumen endotracheal tube. A biopsy forceps, scissors or electrocautery, suction, irrigator are the primary tools used in thoracoscopy.
VATS provides panoramic view of the intrathoracic anatomy, expanded field of vision which allows generous percutaneous dissection, This dissection can be performed by the surgeon while the assistant is manipulating the instruments and the camera man is operating the videoscope as all of them can see the anatomy on the video-monitor simultaneously.
VATS plays a major role in managing chest traumas as it has an accuracy of almost 100% in diagnosing injuries of the diaphragm. Generally speaking, the rate of missed diagnosis using VATS for chest trauma is 0.8%, with a 2% rate of procedure-related complications.
Most of the thoracic traumas do not require major procedures and tube thoracotomy remains the basis of the treatment. Rapid improvements in endoscopic surgical technique and instrumentation expanded the indications of video-thoracoscopy in both diagnosis and treatment of chest traumas.
VATS has been used in both diagnosis and treatment of variant entities of chest traumas as diagnosis of diaghragmatic injuries after penetrating trauma and post-traumatic empyema, chylothorax, mediastinal masses and infections, excision of bronchial cysts, diaphragmatic hernias and injuries, and esophageal surgeries, retained haemothorax and persistent pneumothorax, also in management of ongoing bleeding.
Other than its huge importance in managing chest traumas, VATS is used in various thoracic surgical problems as wedge resection of peripheral pulmonary nodules, closed lung biopsy, approach to apical bullae, aortopulmonary window, mediastinal masses, and lung resection,lung biopsy, cancer and node biopsy, sympathectomy and esophagomyotomy.
Other data
| Title | The role of thoracoscopy in management of chest trauma | Other Titles | دور منظار الصدر فى علاج إصابات الصدر | Authors | Ahmed Ibrahim Amin Hatab | Issue Date | 2015 |
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