Video-assisted thoracoscopic surgery in a high-volume urban trauma centre

Abstract

Background: Tube thoracostomy (TT) is the standard treatment for haemothorax, but 5–30% of cases may result in retained haemothorax. Video-assisted thoracoscopy surgery (VATS) is a recognised treatment for retained haemothorax, although its timing and feasibility can be challenging in resource-limited settings with restricted theatre access. The objective was to evaluate and describe our experience with VATS at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), South Africa.

Methods: This was a retrospective study over seven years (1 January 2017 – 31 December 2023). All adult trauma patients with retained haemothorax who underwent VATS were included. Data were collected from hospital databases, focusing on patient demographics, mechanism of injury, vital signs, radiological findings, indications for VATS, and clinical outcomes.

Results: A total of 71 patients underwent VATS, with 98.6% being male and an average age of 34 years. The procedure was performed for retained haemothorax in 97% (n = 69) of cases and empyema in two patients. Penetrating trauma was the most common cause, with 82% of patients suffering stab wounds and 18% gunshot wounds. The median time to surgery was 5 days, with a median operating time of 77 minutes.

Conversion to thoracotomy occurred in 14% (n = 10) of cases. Intraoperative findings included clots (42%), retained blood (42%), and pus (2.8%). Postoperative complications occurred in 12.7% (n = 9), including pneumonia (2.8%), drain site infections (5.6%), and recurrence of haemothorax (4.2%). The median length of hospital stay after VATS was 6 days, with no in-hospital mortalities.

Conclusions: VATS is a safe and feasible option for managing penetrating chest trauma in resource-constrained environments, with low complication rates and low in-hospital mortality rates.